Chapter 9: Prenatal Assessment

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking; GYN history; STD's; Syphilis

A syphilis infection during pregnancy can cause significant damage to the fetus after the 16th and 18th week of intrauterine life, when they cytotrophoblastic layer of the placental villi has atrophied and is no longer protective. Caused by spirochete Treponema pallidum, syphilis is treated with penicillin or erythromycin. If condition is treated before the 18th week, the fetus is rarely affected. If left untreated, transplacental transmission to the fetus is most likely to occur and may result in deafness, cognitive difficulties, osteochondritis, or fetal death.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Vagina and Pelvis

An essential component of the nurse's role is to explain to the patient what to expect and to help her to verbalize to any fears. Informed consent is needed. First component= assessment of external genitalia General time to check for pediculoisis (pubic lice). Signs of vaginal infection may be indicated by redness, edema, or an offensive vaginal discharge. The presence of lesions, condylomata (human papillomavirus) vesicles (herpes), ulceration (syphilitic chancre) or inflammation need to be recognized and investigated. Bruising/Tenderness may be present as a result of trauma or abuse. Second component= visual inspection of vaginal mucosa and cervix alone with the collection of specimens such as a pap test, cultures for gonorrhea or chlamydia. Third component= the cervix and vaginal mucosa are inspected for color and for the presence of inflammation, lesions, ulcerations, or erosion. Remaining part of assessment includes clinical pelvimetry and the bimanual examinations. Bimanual examination is an evaluation of uterine shape, position, and size. **Uterus is usually anteverted (tipped forward). As it enlarges during pregnancy, the uterus becomes more mindline and globular in shape.** If a uterus is larger than anticipated, it may be associated with miscalculaton of the date of conception, multiple pregnancies, hydatidiform mole, uterine fibroid tumors, or later in pregnancy , a condition known as hydraminos( increase in volume of amniotic fluid) **Women should be reminded to practice Kegel exercises to help maintain perineal muscle tone. ** Rectovaginal examination: Dons a clean pair of gloves, a water based lubricant is applied on fingertips of dominant hand, index finger re-inserted into vagina; middle finger inserted into rectum; rectal finger is advanced forward as the abdomen is depressed with the nondominant hand; palpation of tissue between examining fingers allows for assessment of strength and irregularity of the posterior vaginal wall. The fingers are withdrawn and any stool present is tested for occult blood. Final Component: clinical evaluation of the pelvis known as clinical pelvimetry. The goal of assessment is to recognize any ABNORMALITY in shape/size that may be associated with a difficult or traumatic vaginal birth. Clinical pelvimetry is performed by physician, RN, mid-wife, or advanced practical nurse. Generally not repeated in woman who have previously given birth to an infant weighing 7lb or more unless there is a history of pelvic trauma in the intervening period between pregnancies.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Recording Vital Signs

BP is a particularly important measurement and should be recorded under standardized conditions (making note of the arm used and position of patient). **Because initial prenatal visit may be the patient's first adult interaction with a HCP, indicators of anxiety (tachycardia, and elevated BP) may be present. In these situations, the nurse should record the first set of vital signs and then repeat the recordings later when the patient has had time to become familiar with her surrounding and is more relaxed**.

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Delayed entry into care: Nursing of the Pregnant adolescent: Diagnosis and Planning

Because of unawareness or denial of the pregnancy, adolescents often do not enter the prenatal care system until the 2nd or 3rd trimester. They might be frightened, confused, and unsure of where to go for care. "Risk for Ineffective Health Maintenance r/t lack of knowledge of measures to promote health during pregnancy and family stress" is an appropriate nursing diagnosis for most pregnant adolescent patients.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking

Before initiating the interview, it is helpful for the nurse to review the paperwork to become familiar with the information to be gathered and to ensure an understanding of relevance and appropriateness of the questions to be asked. Initial interview time should be used to build a positive, non-threatening relationship and to gain her confidence. Strategies include: active listening, validating responses when needs, maintaining eye-to-eye contact, and the use of humor as appropriate to relax the patient. Honesty is essential for effective communication. When uncertain in an answer to a question, the nurse should make a note to find the answer and report back to the patient at the end of the interview.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Obtaining a urine Specimen

Before physical, the nurse should ensure that the patient has had the opportunity to void and if needed a midstream urine sample is obtained. A clean sample of urine should be cultured for asymptomatic bacteriuria during the first prenatal visit

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking: GYN history; Screening and Diagnostic Tests During Pregnancy

Before prenatal testing, it is essential to determine the gestational age accurately because of a number of screening and diagnostic tests have different ranges of normality based on the maturity of the pregnancy. First prenatal visit, venous blood samples are taken so that abnormal findings can be identified and promptly treated. A patients blood group and Rh factor; antibody screen, and syphilis screens are done. Hep. B is tested, a CBC (Hemoglobin, Hematocrit, and differential blood count) is obtained. HIV testing is recommended and sickle cell screening.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Performing General Assessment

Begins by simply observing the woman. Information that can be obtained includes her overall health/nutritional status, posture, ease of movement and gait, appearance (clothing, and cleanliness), speech pattern, eye contact, general orientation to person, place, and time **The nurse obtains pre-pregnancy weight (gives indication of adaptation to pregnancy). Result of lordosis (curvature of spine because of weight gain) A dramatic, unintended weight loss can be indicative of severe nausea and vomiting (hyperemesis gravidarum). Height and weight are also recorded and used to calculate patient's BMI.**

Establishing Estimated Date of Birth: Early Term

Births between 37 weeks 0 days and 38 weeks 6 days

Establishing Estimated Date of Birth: Full Term

Births between 39 weeks 0 days and 40 weeks 6 days

Establishing Estimated Date of Birth: Late Term

Births between 41 weeks 0 days and 41 weeks 6 days

Establishing Estimated Date of Birth: Post-Term

Births between 42 weeks 0 days or after

What can the nurses do to help reduce the patient's stress and increase her adherence to the care plan?

By using an individualized approach with a focus on communication, personalized care, and education.

By using the therapeutic communication, what can the nurse gain insight to?

By using therapeutic communication, the nurse can gain insights into the patient's belief system and manage care appropriately. Maintaining a nonjudgmental attitude is essential, for example, if the woman is a late recipient of prenatal care. Creating an atmosphere in which the patient feels accepted and valued for seeking care is a therapeutic, positive approach and one that will hopefully foster patient adherence. Through discussion, the nurse can gain an understanding of the availability and acceptability of traditional health-care services and whether they meet the patient's individual health-care needs. Each culture embraces different customs and health practices that need to be respected and accommodated.

Throughout the childbearing experience, the nurse's primary role is to "CARE" for the patient. What does this acronym stand for?

C-Communicating A-Advocating R-Respecting E-Enabling/Empowering the individual

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking; GYN history; Cervical Cancer

Cervical screening is usually a component of the first prenatal examination. Screening and treatment of cervical dysplasia (cancerous cellular changes) significantly reduce chances that carcinoma will develop.

Family Teaching acronym: "DEEPER CARE": D

Diet -Ideal time to review the family diet and the way foods are prepared. Encourage consumption of whole grains; dark green, yellow, and orange veggies; dry beans, and peas. A variety of fresh or dried/canned fruit; increased low-fat and fat free foods; milk and calcium-rich foods; poultry, low-fat meats, fish that are lowest in mercury (whitefish, haddock, pallock, sole, and trout); nuts; and seeds

Maternal stress during pregnancy can be associated with what problems?

Difficulty to accessing care Transportation issues Appt. Schedules that conflict with work commitments Personal/Family member illness Communication difficulties Perception of staff disinterest Lack of understanding about the importance of frequent prenatal visits are all potential sources of stress that may diminish the patient's ability to comply with the plan of care.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking: Hepatitis B infection

During the prenatal period it is important to screen for hepatitis B because a positive diagnosis will influence both maternal and newborn medical management.

Outline a schedule for and describe the benefits of prenatal care:

Each prenatal visit offers an opportunity for the nurse to provide a comforting, supportive environment for the expectant woman and her family members. During these visits, educational needs can be identified and addressed, concerns can be discussed, reassurance can be provided, and problems or potential problems can be discovered. Promoting maternal physical, psychological, and spiritual health and facilitating maternal empowerment are KEY to promoting and enhancing fetal well-being and positive pregnancy outcome. A

Family Teaching acronym: "DEEPER CARE" E

Education -Many childbirth education options are available to meet the needs of women and their families.

Family Teaching Acronym: "DEEPER CARE" E

Emergencies -Family members need to know the following danger signs of pregnancy and how to seek medical help -Reduction in fetal movements -Signs of preterm labor such as low, dull backache, pelvic pressure feelings, uterine contractions, or menstrual cramps -Vaginal fluid loss or vaginal bleeding -Maternal fever over 100.5 F -Persistent headache associated with blurred vision or flashing lights in front of the eyes -Continuous vomiting with weight loss, dehydration, weakness, dizziness, or fainting. -Couple has an "inner feeling that something is just not right". It is always better to confirm normality rather than deal with an avoidable emergency.

Describe the Care Principles: E

Enable/Empowering: -To provide somebody with the resources, authority, or opportunity to do something -To make something possible or feasible.

Family Teaching Acronym: "DEEPER CARE": E

Exercise -Aerobic exercise maintains physical fitness and promotes self-esteem and body image.

Family Teaching Acronym: "DEEPER CARE" E

Expectations -Pregnancy is a time of great expectations. Families need to know what changes are likely to occur and be able to recognize normal from abnormal so they can recognize when to seek medical assistance.

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Promoting optimal nourishment for the patient and her (Adolescent)

Pregnancy during adolescence is associated with a higher risk for maternal and fetal complications. Pregnant adolescents need more calcium, magnesium, and phosphorous to help meet their own growth needs. Teens often skip meals and have a tendency to choose convenience or "fast food" that are high in calories, fat, and sodium and low in vitamins, minerals, and fiber.

Diminishing Stress: Why is pregnancy a developmental crisis?

Pregnancy is a developmental crisis that necessitates role adaptation and restructuring of tasks involved in daily living. It is a life-changing event that requires adjustments to the many physical and emotional changes that will take place. By nature, change is associated with stress.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Psychological Assessment

Pregnancy is a time of change, and usually change of any nature is linked with additional stress. How an individual deals with stress depends on learned is behaviors, coping mechanisms, and support systems. Each woman's approach to her pregnancy encompasses cultural values and family traditions and beliefs. One's status to relation to marriage or partnership, financial security, career, or educational achievements is influential in shaping the overall childbearing experience. Past obstetric experience including pregnancy outcomes, interactions with care providers, and level of physical health during and after pregnancy are instrumental in forming the woman's attitude toward pregnancy. Ambivalence is a normal initial reaction to pregnancy that usually diminishes as the woman accomplishes developmental tasks of pregnancy.

Establishing the Estimated Date of Birth

The antenatal period begins with first day of the last normal menstrual period and ends when labor begins. This time frame is approx 280 days in length or 40 weeks or 10 lunar months or 9 calendar months. Pregnancy is divided into 3 trimesters. Each trimester is approx 14 weeks or 3 months in duration. Historically, the period from 3 weeks before until 2 weeks after the estimated date of birth was considered "term".

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Performing the general physical examination

The general physical examination is then conducted with sensitivity to lifestyle choices, behaviors, and cultural beliefs. Together with physical data, the nurse should also gather information relating to the patients usual state of health, health promotion and maintenance strategies, and details of present health concerns or symptoms

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking; Social History

This data helps the nurse establish the patient's socioeconomic group and may provide indication of family income, standard of housing, and nutrition. Homeless women may have fears related to acceptance, judgment, costs, and philosophies and or expectations of HCP. Nurses, especially those working in the community, need to advocate for homeless women and their children and explore avenues for bringing prenatal and child care in a non-threatening environment to those in need.

What are the possible nursing diagnoses for the prenatal patient:

-**Knowledge deficit related to normal physiological changes of pregnancy** -**Altered Nutrition Risk: Less than body requirements** -Risk for Fatigue -Risk for Disturbance of body image -Risk for altered role performance -Altered sexual patterns -Family coping -Change in comfort level related to advancing pregnancy -Change in sleep patterns -**Altered urinary elimination due to enlarging uterus or engagement of fetal part** -Anxiety -Adolescent -Family processes, altered

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Delayed entry into care: Three types of denial

-During the first of these clinical types, the teenager realizes that pregnancy is a possibility but continues to hope that it will not come come to fruition, and if it does, that it will disappear on its own accord. -Second type of denial is a continuation of the first except that the teenager actively conceals the pregnancy and deliberately uses whatever skills is necessary to intentionally deceive and hide the changes taking place in her body. -Third is true denial. In this situation, the teenager is absolutely unaware of any of the physical and psychological signs or symptoms of pregnancy and experiences unconscious denial of impending motherhood. In this situation, the onset of labor is truly unexpected. A teenager who endures this type of denial is displaying psychopathology coupled with significant ego pathology. Infants born to this group of teenagers are at highest risk for victims of neonaticide because the mother fails to develop any form of attachment. Neonaticide is defined as the killing of a baby within first 24 hours of birth.

What are the number of issues that affect a woman's willingness to use health-care services:

-Personal beliefs about pregnancy -Cultural expectation -Previous relationships with HCP's -Perceived benefits of prenatal care -Issues in access of care -Medical insurance/Financial support

According to Erikson, there are 4 developmental tasks of adolescence:

-To establish a sense of self-worth and value system -To establish lasting relationships -To emancipate from parents -To choose a vocation

How do you calculate EDD using Naegele's Rule:

7 days are added to the last menstrual period Subtract 3 months add 1 year **Alternative way: add 7 days then add 9 months + year where needed.**

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: The impact of Pregnancy on Meeting the Developmental Tasks of Adolescence

A pregnant teenager is required to be able to make informed decisions regarding continuing the pregnancy, and if the pregnancy comes to fruition, future plans for the child. Meeting the development tasks of being a teenager, coupled with the developmental tasks associated with adapting to become a better mother is essential.

Define pregnancy rate:

defined as the total number of pregnancies, including those that end in spontaneous abortion, elective abortion, or birth.

Define Multigravida

describes a woman who is pregnant for the third time (or more times)

Define Ischial Tuberosity

diameter (also known as the intertuberous or bi-ischial diameter) is a measurement of the distance between the ischial tuberosities. Diameter can be measured with a ruler or with examiner's clenched fist or hand span (exact measurement of fist and hand must be known) A diameter of 11cm is considered adequate for passage of the widest diameter of the fetal head through the pelvic outlet.

Define True Conjugate (conjugate vera)

measurement between the anterior surface of the sacral prominence and the posterior surface of the inferior margin of the symphysis pubis. Cannot be measured directly

Define Parity

refers to the number of pregnancies carried to a point of viability (generally accepted as 20 weeks of gestation) regardless the outcome.

Define Gravidity

relates to the number of times a woman has been pregnant, irrespective of the outcome

Define diagonal conjugate

the distance between the anterior surface of the sacral prominence and the anterior surface of the inferior margin of the symphysis pubis. Performed in lithotomy position

Define Gravid/Gravida

the state of being pregnant/a pregnant woman

Define Nulligravida

used to describe a woman who has never been pregnant

Family Teaching Acronym: "DEEPER CARE" P

Play -Play is essential to health, happiness, and creativity. Fun family (couple) activities refresh, promote optimism, and provide an opportunity to "recharge the connect"

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Obtaining information and Promoting Good Nutrition

**An important nursing goal is to promote appropriate weight gain during pregnancy through healthy nutrition. ** A well balanced diet that contains the necessary vitamins and nutrients is essential. It is important to educate women that prenatal vitamins are an option to ensure that their daily needs are being met. **A women's needs for folic acid double during pregnancy, and ideally supplementation with 400 mcg per day should be initiated prior to conception and continued at least 3 months of pregnancy to help reduce the incidence of open neural tube defects.**

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: The breasts

**Patient assisted to recumbent position for breast examination.** Inspection of the breasts usually reveals pregnancy-related changes including nodularity, striae, and enlargement and hyperpigmentation of nipples and Montgomery tubercles. **Areas of indentation or skin puckering are NOT normal findings. Colostrum, a precursor to breast milk, may be expressed from the nipples are early as the first trimester of pregnancy. Lymph nodes should not be palpable.**

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Fetal Heart Auscultation

**The fetal heart rate is heard most clearly directly over the fetal upper back (the maternal right or left lower abdominal quadrants) in a vertex presentation.** **With a breech presentation, the fetal heart tones may be best heard in the patients right or left upper abdominal quadrants, If fetal heart tones are auscultated most clearly in that location, the patient's care provider should be advised because further assessment may be indicated to confirm the fetal presentation.** **Normal heart rate for a fetus is approx 110-160 bpm.** If a slower heart rate is detected, the maternal pulse should be first evaluated to determine if the two heart rates are synchronous. If they are synchronous, the maternal pulse has inadvertently been auscultated through the abdomen and an attempt should be made to locate the fetal pulse. If the two pulses differ, the nurse should position patient on left side and seek assistance. Oxygen may be administered by mask and the patient should be instructed to take slow deep breaths. The nurse should continue to monitor the FHR and provide explanations to reassure to the patient.** Use of the doppler stethoscope to auscultate fetal heart tones is simple and requires no special skills because placement of the instrument in the general vicinity of the fetal heart will most likely produce audible heart tones. Electronic fetal monitoring during the prenatal period is generally limited to pregnancies designated as being high risk because of maternal or fetal factors. In these situtaions, a nonstress test may be ordered to provide an evaluation of the FHR in response to fetal movement and/or uterine activity. A reactive test (desirable result) is one in which the heart rate accelerates by at least 15 bpm for at least 15 seconds with at least "3 acceleration episodes" in a 20-minute period. Nurses must be cautious not to place too much reliance on technology. Nurses should use clinical skills coupled with evidence based theory to transition from novice to expert practitioner.

When obtaining prenatal history, what skill is paramount importance ?

**The skill that is paramount importance is THERAPEUTIC COMMUNICATION. The information requested can be very personal in nature, and it may be difficult for patients to disclose certain aspects of their past histories. Therefore, care must be taken to manage the environment to promote privacy and provide the patient with physcological and physical comfort.** AVOID medical or technical jargon that may interfere with the patient's understanding, may intimidate her, or cause her to feel embarrassed because of lack of comprehension. Questions should be phrased in a way to encourage the patient to discuss and share information rather than asking close-ended questions that require only a yes or no response.

What are the goals that guide nursing care of the prenatal patient:

**To recognize deviations from the normal** To provide individualized, evidence-based care **To provide culturally appropriate prenatal education designed to meet the patient's learning style and needs**. **To empower women to become actively involved in their pregnancy by being informed recipients and shared decision makers.**

Discuss why ambivalence is frequently experienced during the first trimester:

**When women are faced with a positive pregnancy test result, many women experience ambivalence or begin to question their desire to be pregnant. ** This reaction is a normal response that occurs irrespective of how determined and committed the couple is to the goal of beginning or expanding a family. **Part of the ambivalence relates to the sudden realization that life as it has been known is going to change dramatically and this change will be a lifelong endeavor.** **Women anticipate role changes in relation to her career and relationships needed to prepare for the role of being a mother to an infant who will be dependent on her for survival.** **Recognizing ambivalence and its normalcy in relation to pregnancy during the first trimester and providing support and reassurance are essential in helping the woman positively embrace and celebrate her journey into motherhood.**

Table 9-2: Approx Fundal Height in Relation to Weeks of Pregnancy: 12, 16, 20, 24, 28-30, 32, 36, 38, 40 (weeks of gestation)

12= Level of symphysis pubis 16= halfway between the symphysis pubis and the umbilicus 20=1-2 finger breadths below the umbilicus 24=1-2 finger breadths above the umbilicus 28-30= one-third of the way between the umbilicus and the xiphoid process 32= two-thirds of the way between the umbilicus and the xiphoid process 36= at the xiphoid process 38= 1-2 finger-breadths below the xiphoid process 40=3-4 finger breadths below the xiphoid process

Probable signs of pregnancy:

Abdominal enlargement may also be caused by uterine or abdominal tumors Piskacek's sign (uterine asymmetry with a soft prominence on the implantation side) may also be associated with uterine tumors Hegar's sign- softening of the lower uterine segment may also be caused by pelvic congestion Goodell's sign - Softening of the tip of cervix; may also be caused by infection, hormonal imbalance, or pelvic congestion Chadwick's Sign; violet-bluish color of the vaginal mucosa and cervix; may also be caused by pelvic congestion, infection, or a hormonal balance Braxton Hicks Contractions; intermittent uterine contractions; may also be associated with uterine leiomyomas (fibroids) or other tumors Positive pregnancy test; may occur from certain meds, premature menopause, choriocarcinoma (malignant tumors that produce human chorionic gonadtropin) or the presence of blood in the urine Ballottment- passive movement of the unengaged fetus; may be because of uterine tumors or cervical polyps instead of the presence of a fetus

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Identifying Adolescents at Greatest Risk for Unwanted Pregnancy

Adolescents who lack the support, security, and love of a family home are more likely to engage in high-risk behaviors including sex at an early age, multiple sexual partners, failure to use contraception, and unplanned pregnancy. Incarcerate juveniles constitute the most vulnerable group, especially when placed in an environment away from family support. These teenagers often have histories of physical neglect as well as severe physical, emotional, and sexual abuse. This group is more likely to experiment with high-risk behaviors such as tobacco and substance abuse, gang involvement, and violence.

Environmental Hazards

Adverse birth outcomes including congenital anomalies, intrauterine growth restriction, and preterm birth have been linked to in utero exposure from air pollutants. Nurses can help to improve the fetal environment by educating women about the dangers of direct and passive smoking during pregnancy. Effects of tobacco use during pregnancy are well documented and predispose to premature rupture of the membranes, preterm labor, placental abruption, placenta previa, and infants who are small for gestational age. The detrimental effects on fetus/neonate continue well into childhood and are associated with problems such as upper respiratory infections, childhood asthma, and wheezing.

Describe the Care Principles: A

Advocate: -One who argues for a cause; a supporter or defender -one who pleads in another's behalf; an intercessor: Advocates for abused children and spouses

Presumptive signs of pregnancy:

Amenorrhea (absence of menses) is one of the earliest symptoms and is especially significant in a woman whose menstrual cycle is ordinarily irregular. Amenorrhea may also be caused by chronic illness, infection; or endocrine, metabolic, or psychological factors Nausea and Vomiting ("morning sickness") may actually occur at any time and women who experience this symptom tend to have a decreased incidence of spontaneous abortion and perinatal mortality. N/V may be caused by infection or gastrointestinal or emotional disorders. Frequent urination is caused by pressure exerted on the bladder by enlarging uterus. Urinary frequency may also be caused by infection, cystocele, pelvic tumors, or urethral diverticula. Breast tenderness results from hormonal changes during pregnancy. This symptom may have also be associated with premenstrual syndrome, mastitis, and pseudocyesis (false pregnancy) Perception of fetal movement (quickening) occurs during the second trimester. The sensation of fetal movement may also result from flatus, peristalsis, and abdominal muscle contractions Skin changes include stretch marks (striae gravidarum) and increased pigmentation. These changes may also result from weight gain and oral contraceptive pills. Fatigue also may be associated with illness, stress, or lifestyle changes.

Define acronym GTPAL

G-Gravida T-# of term deliveries P-#of preterm deliveries A-# of Abortions (spontaneous, and induced) L- # of Living Children

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Delayed entry into care: Nursing of the Pregnant adolescent: Interventions: Strategies to promote a Healthy Pregnancy

Nurse helps locate a prenatal clinic that schedules appts in the late afternoon or evening when needed. Works with community resources to arrange for transportation to the clinic.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Skin

Assessment of skin may reveal pregnancy-associated changes such as chloasma (mask of pregnancy) and hyperpigmentation of the areolae, vulva, abdomen, and linea. The skin is evaluated for color consistent with the woman's ethnic background and for the presence of lesions or indicators of drug abuse (skin scratches, bruising, track marks, nasal discharge, or irritated mucosa and constricted or dilated pupils)

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Delayed entry into care: Nursing of the Pregnant adolescent: Assessment

Assessment: Initial visit includes a personal health history and family history to determine whether medical problems such as diabetes or infectious diseases may threaten maternal or fetal health. Throughout pregnancy, patient should be monitored for iron deficiency anemia, STI/STD and preeclampsia. Should be assessed for alcohol and drug use and screened for sexual abuse. Therapeutic communication with the adolescent is enhanced when the interview is conducted in a warm, conversational style that conveys caring and acceptance. Important to assess knowledge and level of understanding concerning personal care during pregnancy and care of infant following birth. Collaboration of physician, nurse, health educator, nutritionist, school counselor, and social worker is essential in optimizing outcomes for the young parent and her fetus. Educational planning on prenatal visit is individualized to meet the adolescent's specific needs and can be developed on the initial visit. Framing the physical examination in a friendly, learning context helps to diminish the young patient's anxiety and fear and reinforces the information provided at each visit. Use of the doppler stethoscope reinforces the presence of the fetus and helps the teenager acknowledge the reality of her pregnancy.

Family Teaching Acronym: "DEEPER CARE" A

Attitude -Positive thinking is under each individuals control but can be modeled. A positive attitude to life is associated with released stress, improved coping abilities, improved immunity, and greater sense of well-being

What are the strategies for Hepatitis Carriers:

Avoid drugs that are hepatotoxic such as acetaminophen (Tylenol) Choose noninvasive prenatal diagnosis techniques Pediatrician should be aware of carrier Practice daily living of covering cuts, lesions, and not sharing toothbrushes or razor Neonate will receive Hep. B immunoglobulin @ birth Method of Birth does not matter **If neonate gets vaccine, breastfeeding is NOT contradicted**

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking; Biographical Data

Collection of the patient's biographical data, medical history, psychosocial history, and medical examination are essential components of the first visit. Completing a prenatal history form with the patient enables the nurse to provide personalized education that focuses on the risk factors pertinent to that individual. The history should also include information concerning complementary and alternative therapies. An increasing number of individuals routinely use herbal or homeopathic remedies. Some of these substances such as red raspberry tea, are safe and may be beneficial. Blue cohosh may be harmful if taken during pregnancy. Biographical info includes: Contact info, address, phone number, occupation, education level, marital/relationship status. To ensure currency it is important to confirm contact information every 2 months throughout the pregnancy.

Describe the Care Principles: C

Communicating: -The exchange of information between individuals, for example by means of speaking, writing, or using common system of signs or behavior. -A spoken or written message -The communicating of information -A sense of mutual understanding and sympathy

Family Teaching Acronym: "DEEPER CARE" C

Communication -Effective communication is essential to promote family cohesiveness. Communication includes both verbal and nonverbal language such as body posture, gestures, facial expressions, and tone of voice. Within family, communication needs to be open and truthful and received in a nonjudgmental and accepting manner, ultimately affirming and supporting one another.

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: The adolescent Expectant Father

Confusion, depression, and guilt may predominate as the young expectant father struggles with the conflicting tasks of adolescence and impending fatherhood. Nurses must guard against stereotyping young expectant fathers as being irresponsible and disinterested. Many genuinely care and wish to be involved. When desired by the pregnant adolescent, the father's participation should be encouraged. It is a source of additional support for the young patient and allows the father an opportunity to work toward defining his role as a parent.

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Delayed entry into care

Denial is a common reaction to an unwanted and unplanned pregnancy, is often the reason why adolescents do not seek early prenatal care. Unfortunately, denial and postponement of care may place the teenager and her fetus at a greater risk for medical problems. Complication such as: iron deficiency anemia, preterm labor, and preeclampsia may progress without detection and treatment. Without ongoing emotional support and education throughout pregnancy, the teenager enters labor psychologically unprepared and lack a knowledge base to understand the natural events that surround birth.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking: Gynecological History

Nurse needs to obtain a concise GYN history primarily to determine if any event in the patient's past places the current pregnancy at risk or warrants further investigation. Women age 35 and older and foreigners should be questioned about utero exposure to diethylstilbestrol (DES). DES is a non-steroidal, synthetic estrogen that is several times more potent than natural estrogens.

Positive Signs of Pregnancy:

Fetal heartbeat Visualization of the fetus Fetal movements palpated by the examiner

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: The impact of Pregnancy on Meeting the Developmental Tasks of Adolescence : What 4 tasks must be developmentally met for a teenager

For a teenager to successfully adapt and fulfill the role developmental tasks must be met: - Gain acceptance of pregnancy: This involves disclosing the presence of pregnancy to her family, the father of the child, and her friends: Facing family reactions and hopefully gaining support. -Set goals: Make realistic and attainable plans for the future. These goals will be different from her original ones and will focus on her role as a mother of dependent child. -View self as a mother: This task addresses self-image and redefining self as a woman with a child rather than as a teenager with the freedom to explore being an adolescent and the opportunity to mature gradually. -Grow up: Being a competent mother demands maturity with the ability to place someone else's needs before one's own. Developmentally, teenagers are typically at an egocentric stage of development. Being a mother is demanding and requires the sacrifice of being a care free teenager.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Uterine Size and Fetal Position

Fundal Height is an indication of uterine size; The relationship of the fundus (top part) of the uterus to specific abdominal maternal landmarks is used throughout pregnancy as a gauge to assess fetal growth. The fundal height can be measured by using tape measure or finger-breadths in combination with known maternal landmarks.

What are the 4 basic pelvic types?

Gynecoid Android (male) Anthropoid (non-caucasian races) Platypelloid (most rare)

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking; GYN history; STD's; Herpes Simplex Virus

HSV-1, transmitted non-sexually, is most commonly associated with fever blisters. HSV-2 is usually transmitted sexually and is associated with genital lesions, although depending on sexual practices. **Initial HSV genital infection generally produces flu-like symptoms including malaise, muscle aches, and headache accompanied by dysuria and the appearance of multiple painful blister-like lesions. ** HSV-2 infection during pregnancy can have adverse effects on both the mother and her fetus. Primary infection during the first trimester is associated with congenital infection and increased risk of pregnancy loss. NO CURE FOR GENITAL HERPES

How is Hep. B contracted?

Hep B is contracted through sharing of needles, being sexually active, and IV drug users.

Antenatal care must be consistently accessible and responsive while incorporating patient-centered interventions, thereby removing barriers that prevent access to care. How do nurses achieve this goal?

Nurses achieve this goal by promoting optimal prenatal care for all women. An integral aspect of all prenatal nursing care involves actively listening to the woman, providing individualized education, and respecting her choices. The woman has the right to expect continuity of care, clear explanations, consistent information, and the opportunity to discuss any aspect of her care at any time.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking: Intimate Partner Violence (IPV):

IPV known as domestic violence is the most common form of violence experienced by women worldwide. A non-threatening approach is to ask patients directly whether they feel safe going home and whether they have been hurt physically, emotionally, or sexually by a past or present partner. If partner has accompanied with patient, questions are asked at a later date. Sequelae of abuse include depression, anxiety, substance abuse, and PTSD. As a women's advocate, nurses have a duty to be observant,active listening, and to use communication skills to gain clarification and understanding.

Caring for a Woman being Jehovah's Witness:

Identifying a parent as Jehovah's is an essential key step in prenatal care. Ideally, at the first prenatal visit or soon afterward, discussion should center on blood products that are acceptable to the patient and what alternatives are available.

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Cultural Influence on Adolescent Pregnancy

In the US, African -American and Hispanic adolescents represent the groups most likely to engage in early sexual activity. Along with cultural influences, many other factors such as education, spiritual beliefs and group support, family, structure, and income also impact the occurrence of adolescent pregnancy.

In both local and national arenas, how can nurses empower women and their families:

Nurses can empower women and their families by advocating for prenatal care that is readily available and affordable for all, especially for low-income and vulnerable populations. The "health-care safety net" is one mechanism for providing health services for the needy. Despite the availability of these types of programs, there are still women who receive inadequate or no prenatal care. (Health-care safety net consists of a wide variety of providers who deliver care to low-income and other vulnerable populations, including those uninsured and under medicaid).

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking; GYN history; STD's; HIV

Infection leads to AIDS **Perinatal transmission may occur transplacentally, at birth from exposure to maternal blood and vaginal secretions, and via breast milk** **Maternal treatment with zidovudine (AZT, Retrovir) reduces the risk of perinatal transmission and the risk of infant death. Elective cesarean birth has been shown to significantly reduce the risk of transmission from the mother to infant. HIV testing done by ELISA assay on a blood sample. Confirmed by Western Blot Test. ** If a rapid HIV test result in labor is positive, immediate initiation of antiretroviral prophylaxis should be initiated without waiting for the results of the confirmatory test. Nurses need to be patient advocates and ensure that patients receive individualized and informed care. One aspect of the nurse's role in this situation is to make certain that each patient receives nonjudgemental, comprehensive pre and post counseling in relation to HIV testing.

Estimated Date of Delivery:

Is based on the date of of the last normal menstrual period (LMP) with the assumption the woman has a 28-day cycle.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking: Dental Health

Link between periodontal disease in pregnancy, gingivitis, and preterm labor. Believed that oral bacteria and their products travel via the bloodstream to the placental membranes where an inflammatory response occurs. Inflammation may trigger onset of preterm labor **Oral caries may also pose a greater threat during early pregnancy when vomiting from "morning sickness" occurs. Vomiting causes the mouth to harbor an acid environment that favors cariogenic activity. Pregnant woman need to get regular dental examinations.**

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Over age 35

Maternal age is an important factor in management of pregnancy. As maternal age increases, there is a greater likelihood of preexisting medical conditions such as diabetes and hypertension which may be associated with maternal morbidity and poor fetal outcomes. Benign uterine leiomyomas (fibroid tumors) occur with greater frequency in women over age 35 and may interfere with cervical dilation during labor and cause postpartum hemorrhage. Others include vaginal bleeding, preeclampsia, multiple gestation, gestational diabetes, preterm labor, dysfunctional labor, and cesarean birth are also increased in older primigravidas. Fetus is at greater risk for low birth weight, macrosomia, chromosomal abnormalities, and congenital malformations. Preconception and prenatal care for women over 35 is focused on recognizing chronic medical conditions ( hypertension, diabetes) and identifying detrimental lifestyle habits such as alcohol, drug, and tobacco use. Reactions for pregnancy range from shock and disbelief and joy. Many have reached the point in their lives where they have financial support and economic stability, established careers, and security of stable interpersonal relationship. Nurse's must be sensitive to each woman's situation and needs. Peer support may be lacking even in a stable time in their life. Effective nursing interventions include providing information and referral genetics counseling and specialized diagnostic testing; structuring prenatal education; and offering assistance in locating support groups, exercise, and childbirth prep classes. Physical examination should be conducted with a SPECIAL FOCUS on the identification of breast abnormalities and circulatory problems!! After careful breast examination, the patient should be encouraged to continue with monthly breast-self examination because the incidence of breast cancer is increased in older woman. Particular attention should be paid to inspection of the lower extremities because varicosities are also common in older women. During 1st trimester, nurse should carefully assess for the presence of fetal heart sounds because the incidence of hydatidiform mole is increased in women over age 40.

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Nurse's Role in the Adolescent Community:

Nurses can help the nation to achieve this goal by heightening public awareness of the complex personal and societal repercussions of adolescent pregnancy. Nurses can also empower women and their families with factual information and strategies to reduce unwanted pregnancies among this young population. In the community setting, nurses can advocate for responsible sexual behavior by providing educational programs for youth in schools, churches, clubs, and after school activities. In clinical setting, nurses can listen to, counsel, and educate young patients to help prepare them for responsible sexual decision making. Nurses can also empower mothers and fathers of young adults with methods for facilitating open, honest family discussions about sexuality and sexual behavior. Strategies that use a holistic family approach such as promoting open communication between parents/guardians and teenagers, together with teaching self-respect, setting boundaries, and providing appropriate supervision, are essential components of any successful approach to reduce teenage pregnancy.

What must nurses be cognizant of?

Nurses must be cognizant of the fact that women, irrespective of culture, may face different stressors and often require a variety of resources and interventions to help them deal effectively with stress and improve their utilization of prenatal care. Pregnancy is a time of entering the unknown. The pregnant woman faces unpredictability and quite possibly the loss of control. Women need to be able to adapt to unexpected situations and meet unforseen challenges as the pregnancy advances.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking; GYN history; STD's; Chlamydia, Gonorrhoeae

Obtained through pelvic examination Secretions from the cervix, vagina, and anus may be used to obtain samples for culture media. Chlamydia is a bacterial infection that is prevalent in sexually active populations, especially those under age of 25. Most patients with infection are asymptomatic. Complication to fetus include salpingitis, pelvic inflammatory disease, infertility, ectopic pregnancy, premature rupture of the membranes, and preterm birth. Transmission to the neonate may occur during birth and results in ophtalmia neonatorum, and chlamydial neonatal pneumonia. Treated with oral anti-infectives or penicilin-based agents. Gonorrhea is caused by gram (-) intracellular diplococcal bacteria Neisseria gonorrhoeae. It is readily treated with antibiotics. When left untreated, ascending maternal infection may occur after rupture of the membranes. Transmission of the fetus can occur during vaginal delivery and may result in disseminated infection and ophtalmia neonatorum.

Women may use a number of defenses emotionally to deal with abuse; what is one method?

One method is recreational use of drugs Look on table 9-1 on page 255 Women must be internally motivated to get over drug abuse!!!

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Physical Assessment; Preparing the patient

Patient should be given adequate private time to prepare for the examination and encouraged to void if needed. **It is essential to properly prepare the environment before the examination. The room should be warm, with a cover for the patient and a gown for her to wear. Ensure privacy. ** Before exam, patient should be aware of what the exam will involve and what she is expected to do. A consent form must be obtained. Consent is essential for a patient who has a history of being sexually abused. Physical examination should be head to toe to reduce omitting a component. Essential for nurse to use good communication skills to advocate for and treat patient with respect.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment:

One of the first maternal tasks of pregnancy is "ensuring a safe passage". This stage encompasses the active lifestyle choices that the woman makes and the behaviors that she adopts to promote her own and her fetus's well-being. One of the early decisions the patient and the partner makes concerns choosing a care provider. It is recommended that every patient gets this arranged in the first trimester. A woman's journey through the pregnancy experience can have long-term effects on her self-perception and self-concept. Thus, it is especially important that the patient choose a care provider with whom she can openly relate and who shares the same philosophical views on the management of pregnancies. During the initial interview with a care provider, it is helpful for a woman to discuss the provider's work schedule and how births that take place when the provider is not on call are managed. The provision of prenatal care offers the nurse a unique opportunity to make a difference not only in the patient's life but also in the lives of her family. To truly take advantage of this opportunity, the nurse needs an expansive array of tools including the ability to communicate effectively with patients irrespective of cultural background, education level, health-care beliefs, or age to understand family and group dynamics; and to accept diversity without prejudice or bias.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking: Obstetric History: Previous Pregnancies

One of the first steps in the prenatal interview process is to obtain an accurate and detailed obstetric history that provides the interviewer with essential information so that questions can be formulated and asked in a manner that respects and acknowledges the patient's past experiences with pregnancy. Previous history of preeclampsia increases the woman's likelihood of recurrence during subsequent pregnancies. **Preeclampsia is recognized via two classic symptoms: elevated BP, and proteinuria. ** Patients who indicate a pattern of repeated spontaneous miscarriages most lkely would benefit from genetic counseling, preferably during the preconception period. Although it is never possible to guarantee a family a "perfect" baby , nurses can help recognize patients who may benefit from preconception or prenatal counseling and genetic testing. The loss of a previous pregnancy or the death of an infant brings a staggering cascade of emotions to a subsequent pregnancy. Fear of another fetal loss or infant death undoubtedly increases the couple's anxiety and stress. During the initial prenatal visit, it is especially important to educate the woman about the developing embryo/fetus during the first few weeks of pregnancy. This is a time when the woman needs to be particularly conscious of potential teratogens. **A teratogen is a substance that adversely effects fetal development.**

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking: Eye Health

Ophthalmic evaluation is recommended during early pregnancy, most often during first trimester, or any time visual changes occur. Especially important for women with medical conditions such as essential hypertension, Graves disease, or diabetes mellitus and for woman who wear contact lenses.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Head, Neck, Lung Assessment

Patient in sitting position, physical examination proceeds in a head to toe fashion beginning with general evaluation of skin and hair. **Hair loss, common during the postpartum period can be indicative on vitamin or mineral deficiency**. **Increased levels of estrogen are responsible for a number of objective and subjective changes such as hypertrophy of the gingival tissue, nasal stuffiness, and an increased tendency for nosebleeds.** **Thyroid gland is palpated while patient remains in sitting position. Enlargement is common during pregnancy because of increased vascularity and hyperplasia of the glandular tissue. ** Anterior and posterior lung sounds are auscultated and the cardiac rhythm and rate are evaluated for adventitious sounds. **During pregnancy, 90% of women display systolic heart murmurs because of an increase in blood volume. Heart sounds should be evaluated with the woman in both a sitting and lying position.** **As patient's pregnancy advances, the patient's breathing becomes thoracic in nature (rather than abdominal) because of enlarged uterus.**

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: The abdomen

Patient should be draped to maintain her privacy, comfort, and body temp. Abdominal shape is assessed and inspected for scars and is documented, linea nigra, striae gravidarum, or signs of injury (bruising) Patients generally become aware of fetal movements around the 16th to 20th week of pregnancy. Primagravida usually can identify movements 18 to 20 weeks, a multigravida can notice movements as early as the 16th week.

When does prenatal care begin, and describes the prenatal visit:

Prenatal care begins in the first trimester of pregnancy, **when the patient is seen every 4 weeks until she reaches 28-32 weeks gestation time**. At that time, the appointment are changed to visits every 2 weeks and then occur weekly from 36 weeks of gestation until birth.

Define the Acronym "RADAR" in regards to IPV

R-routinely screen every patient A-Ask directly, kindly, and in a nonjudgmental manner D-Document your findings A-Assess the patient's safety R-Review options and provide referrals

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Adolescent: Impact on society

Strategies have arranged from public awareness campaigns to public chastisement, conviction of a sex offender, and institutionalization for unacceptable moral behavior. Providing teenagers with sex education is an approach that endeavors to take secrecy out of sex and instead provide basic, accurate information. It is believed that this strategy will empower adolescents with the knowledge needed to make informed decisions, or in the least, with confidence necessary to seek guidance. Nurses need to incorporate information into the design of health education classes that will enable teenagers to understand the better process of making an informed decision. Ensuring that the adolescent has a realistic perception of related risks and the population short-term and long-term outcomes is an essential component of any educational effort.

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Over age 35: Screening for Fetal Chromosomal Abnormalities

Recommend that all pregnant woman get a screening test for Down syndrome. Down syndrome (trisomy 21) increases dramatically with maternal age. Essential before implementing the test that the patient and her significant other and family support are provided with appropriate information concerning the test. Information is valuable in helping them understand the reliability of the screening or diagnostic test and the implication of results. Early diagnosis gives the parent the opportunity for early termination of the fetus, or gives parents time to make preparations for raising a child with Down syndrome. Patient deserves un-biased counselor who can provide continuity of care and up-to-date , accurate, and in-depth information. The counselor also needs to be able to facilitate open discussion where the patient can voice spiritual beliefs, financial situation, family dynamics, emotional feelings, and cultural, philosophical, and ethical values. Screening for fetal chromosome anomalies include : Trisomies :13 (Patau syndrome); 18 (Edward's syndrome); and 21 (Down syndrome)

Family Teaching Acronym: "DEEPER CARE" R

Relaxation -Relaxation benefits all family members by boosting immunity, lowering BP, reducing stress, and increasing energy levels. Activities may include meditation, yoga, visualization/positive thinking

Family Teaching Acronym: "DEEPER CARE" R

Respect -Healthy relationships require mutual respect, honesty and trust. Compromise, negotiation, and shared responsibility are intrinsic to a positive relationship, as is equal distribution of power and control

Describe the Care Principles: R

Respect: -To feel or show admiration and deference toward somebody or something. -To pay due attention and to refrain from violating something -To show consideration or thoughtfulness in relation to somebody or something

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: Subsequent Prenatal Visits

The plan of care for the first prenatal visit should be amended to meet each individual woman's needs, based on medical, social, cultural, and individual factors. Usually not in-depth, but should be designed to recognize any deviations from nor so that the appropriate investigations can be ordered to manage care accordingly. **Normally patients are seen at a frequency of every 4 weeks until 28-32 weeks of pregnancy, then every 2 weeks until 36 weeks, and then weekly until childbirth.** **At each visit, standard of care includes evaluation of maternal weight gain, blood pressure, urine (for glucose and protein), uterine growth, fetal heart tones, fetal movements. Patient is also assessed for edema.** Evaluation of fetal well-being includes documentation of the patient's perception of fetal movements. Depending on the circumstances, fetal evaluation may also include electronic heart rate monitoring, ultrasonograpy to monitor growth patterns, and placental aging. Look at Box 9-9 on page 277

What is the prenatal objective and goal?

The prenatal objective is to provide user-friendly service that is efficient, effective, caring, and patient centered. One major goal for this first visit is to explain the purpose of prenatal care and to establish specific goals. Care goals are determined through shared decision making with the patient and focus on promoting maternal and fetal health through assessment, education, screening, diagnosis, and treatment.

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking; GYN history; STD's

The presence of an STD can predispose to a number of adverse pregnancy outcomes including ectopic pregnancy, spontaneous abortion, preterm labor, and increased neonatal morbidity. **Sexual history should include signs and symptoms of (vaginal discharge, rectal discharge, dyspareunia, ulcers, rashes, or anogenital itching) that may be indicative of infection. ** High risk behaviors such as IV drug use, acquisition of tattoos, exposure to blood or blood products, or sex with an individual from a high risk category should be noted.

Define Seroconversion

The process whereby an individual develops antibodies in response to an infection and subsequently tests positive when screened because of the presence of antibodies.

What are the essential components of caring communication skills?

The qualities of comfort, acceptance, responsiveness, and empathy are the components. Comfort and acceptance refer to one's ability to deal with difficult topics without displaying uneasiness and accepting attitudes the patient brings to the interview without showing annoyance or intolerance. Responsiveness and empathy refer to the quality of reacting to indirect messages expressed by the patient. Empathetic listening helps the nurse truly understand what the patient is actually saying

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking: Immunizations

Vaccination against influenza is considered safe throughout pregnancy, and preventing influenza during pregnancy is essential for prenatal care and the most effective strategy is an influenza immunization. Rubella (German Measles) is the most commonly recognized viral infections known to cause congenital problems. Pertussis (whooping-cough) is an extremely contagious bacterial infection caused by the gram-negative coccobacillis Bordetella pertussis which causes disease through the elaboration of toxins that damage respiratory epithelium. A tetanus and diphtheria booster vaccination is indicated during pregnancy for a woman who has never gotten the vaccine for tetanus, diphtheria, and pertussis (Tdap) or if 10 years have elapsed since immunization. Tdap should be administered during the third or late second trimester (after 20 weeks of gestation)

Summarize the components of the first and subsequent prenatal visits in relation to history taking, physical assessment, and ongoing risk assessment: History Taking: Current pregnancy

When obtaining the medical history, the nurse should begin with the events of the current pregnancy. For the woman, the current pregnancy is the issue of most importance to her at this time and what has brought her to the office for prenatal care. The signs and symptoms of pregnancy are divided into three classifications: **Presumptive ( experienced by the patient); probable (observed by the examiner), and positive (attributable only to the presence of the fetus)**

Discuss Aspects of Prenatal care for the adolescent and for women over age 35: Adolescent :Sexual Behavior and Pregnancy

Without advanced education, their earning capacity and career opportunities are somewhat limited, and this factor may become a life-long limitation. In addition to many developmental, social, educational, and lifelong consequences for both the young mother and her child, the teenage patient is also at additional risk for a host of obstetric complications including anemia, preeclampsia, and preterm birth.

Define hydraminos

an increase in volume of amniotic fluid.

Define Primigravida

is a pregnant woman for the FIRST time

Define Secundigravida

is a pregnant woman for the SECOND time