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The Prenatal Assessment

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Title: Chapter 9 Author: RVCC Last modified by: The Family Created Date: 8/28/2006 12:56:18 AM Document presentation format: On-screen Show (4:3) Company – PowerPoint PPT presentation

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Title: The Prenatal Assessment


1
Chapter 9
  • The Prenatal Assessment

2
CAREing for the Patient (Prenatal Period)
  • Nurses role
  • Communicate
  • Advocate
  • Respect
  • Empower women
  • Help woman become informed recipient of care
  • Facilitate shared decision-making

3
Stress and Pregnancy
  • Nurses role
  • Focus on communication, personalized care,
    education
  • Provide support
  • Offer stress management techniques
  • Gain womans confidence

4
Healthy People 2011
  • Access to care
  • Barriers to service
  • Health insurance
  • Health provider barriers
  • System barriers
  • Social disparities

5
The First Prenatal Visit
6
Nurses RoleFirst Prenatal Visit
  • Build positive, nonthreatening relationship
  • Therapeutic communication
  • Avoid medical/technical jargon
  • Provide user-friendly service
  • Goal to explain purpose of prenatal care to
    establish specific goals

7
Comprehensive Health History
  • Biographical data
  • Social historyintimate partner violence and drug
    use
  • Psychological assessment
  • Obstetric history
  • Current pregnancy

8
Signs and Symptoms of Pregnancy
  • Presumptive
  • Amenorrhea
  • Nausea/vomiting
  • Urinary frequency
  • Breast tenderness
  • Probable
  • Piskacek sign uterine asymmetry with a soft
    prominence on the implantation side
  • Hegar sign softening of the lower uterine
    segment
  • Chadwick sign violet bluish color of the vaginal
    mucosa and cervix

9
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10
Positive Signs of Pregnancy
  • Fetal heartbeat
  • Fetal movements
  • Visualization of fetus

11
Estimated date of birth (EDB)
  • Naegeles rule add 7 days, then subtract 3
    months from the date of the last normal menstrual
    period
  • History
  • Intercourse/signs and symptoms
  • Date of last normal menstrual period

12
Pregnancy Classification System
  • Gravid/gravida/gravidity
  • Nulligravida never experience pregnancy
  • Primigravida pregnant for the first time
  • Multigravida pregnant for the third time
  • Parity number of pregnancies carried to
    viability age

13
Pregnancy Classification System
  • GTPAL classification system
  • G- gravida
  • T- number of Term pregnancies
  • P- number of preterm deliveries
  • A- abortions both spontaneous and induced
  • L- number of living children

14
Medical History
  • Medical conditions
  • Dental health
  • Eye health
  • Immunizations
  • Hepatitis B infection

15
Gynecological History
  • Environmental hazards
  • Teratogens
  • DES exposure diethylstilbestrol (nonsteroidal)
  • TORCH
  • Breast surgery/cancer/lumps/biopsies
  • History of rape, abuse

16
Gynecological History
  • Infertility
  • Surgeries
  • Therapeutic/elective pregnancy terminations
  • History of STIs
  • Cervical pathology

17
Homework 1 Based on this diagram, develop your
concept map on how to provide prenatal care to a
client who came in for her first prenatal visit.
2. Write up of Changes of pregnancy by system
tests.
18
Screening and Diagnostic Tests
  • Screening
  • Rh factor, antibody screen
  • Sexually transmitted infections
  • HIV
  • Cervical cancer
  • Diagnostic
  • To confirm presence of disease

19
Prenatal Physical Examination
  • Prepare patient and environment
  • Obtain consent to be examined
  • Ongoing interaction
  • General assessment
  • Nutritional assessment
  • Abdominal palpation

20
FUNDAL HEIGHT MEASUREMENT
21
Leopold Maneuvers
  • First determine fetal body part that occupies
    uterine fundus
  • Second determine location of fetal spine
  • Third compare fundus with lower uterine segment
  • Fourth determine ballottement engagement

22
Preparation
  • Instruct woman to empty her bladder first.
  • Place woman in dorsal recumbent position, supine
    with knees flexed to relax abdominal muscles.
    Place a small pillow under the head for comfort.
  • Drape properly to maintain privacy.
  • Explain procedure to the patient.
  • Warms hands by rubbing together. (Cold hands can
    stimulate uterine contractions).
  • Use the palm for palpation not the fingers.

23
First Maneuver
  • Purpose
  • First Maneuver To determine fetal part lying in
    the fundus.
  • To determine
    presentation.
  • Procedure
  • Using both hands, feel for the fetal part lying
    in the fundus.
  • Head is more firm, hard and round that moves
    independently of the body.
  • Breech is less well defined that moves only in
    conjunction with the body.

24
PRESENTATION
25
Second Maneuver
  • Purpose To identify location of fetal back. To
    determine position.
  • Procedure
  • One hand is used to steady the uterus on one side
    of the abdomen while the other hand moves
    slightly on a circular motion from top to the
    lower segment of the uterus to feel for the fetal
    back and small fetal parts.

26
Second Maneuver
  • Use gentle but deep pressure
  • Fetal back is smooth, hard, and resistant
    surfaceKnees and elbows of fetus feel with a
    number of angular nodulation

27
Third Maneuver
  • Purpose
  • To determine engagement of presenting part.
  • Procedure
  • Using thumb and finger, grasp the lower portion
    of the abdomen above symphysis pubis, press in
    slightly and make gentle movements from side to
    side.
  • Findings
  • The presenting part is engaged if it is not
    movable.
  • It is not yet engaged if it is still movable.

28
Fourth Maneuver
  • Purpose
  • To determine the degree of flexion of fetal head.
  • To determine attitude or habitus.
  • Procedure
  • Facing foot part of the woman, palpate fetal
    head pressing downward.Use both hands.

29
Leopold Maneuvers
30
Fetal Heart Auscultation
  • 120 to 160 beats per minute
  • Fetoscope
  • Doppler ultrasound stethoscope
  • Electronic fetal monitoring for high-risk
    pregnancies
  • Non-stress test

31
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32
Subsequent Prenatal Examinations
  • Maternal weight gain/edema
  • Blood pressure
  • Urine
  • Uterine growth
  • Fetal heart tones
  • Fetal movements and presentation

33
Assessing Special Populations
34
Teenage Pregnancy
  • Nurses role
  • Heighten public awareness
  • Empower women/families to reduce unwanted
    pregnancies
  • Advocate for responsible sexual behavior
  • Impact on society

35
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36
  • Teen pregnancy accounts for more than 9 billion
    per year in costs to U.S. taxpayers for increased
    health care and foster care, increased
    incarceration rates among children of teen
    parents, and lost tax revenue because of lower
    educational attainment and income among teen
    mothers.4
  • Pregnancy and birth are significant contributors
    to high school drop out rates among girls.
  • The children of teenage mothers are more likely
    to have lower school achievement and drop out of
    high school, have more health problems, be
    incarcerated at some time during adolescence,
    give birth as a teenager, and face unemployment
    as a young adult.

37
Nursing Care of Pregnant Adolescent
  • Assessment
  • Closely monitor for iron deficiency anemia, STIs,
    preeclampsia
  • High-risk behaviors
  • Knowledge regarding personal care and care of
    infant
  • Promote optimal nutrition
  • OB Exam 1 (covers week 1 lecture Changes of
    Pregnancy)
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