The Prenatal Assessment. Nurse’s role ◦ Communicate ◦ Advocate ◦ Respect ◦ Empower women...

The Prenatal Assessment

Nurse’s role◦ Communicate◦ Advocate◦ Respect◦ Empower women◦ Help woman become informed recipient of care◦ Facilitate shared decision-making

Nurse’s role◦ Focus on communication, personalized care,

education◦ Provide support◦ Offer stress management techniques◦ Gain woman’s confidence

Access to care Barriers to service Health insurance Health provider barriers System barriers Social disparities

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

Biographical data Social history—intimate partner violence

and drug use Psychological assessment Obstetric history Current 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

Fetal heartbeat Fetal movements Visualization of fetus

Naegele’s 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

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

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

Medical conditions Dental health Eye health Immunizations Hepatitis B infection

Environmental hazards◦ Teratogens

DES exposure: diethylstilbestrol (nonsteroidal) TORCH

Breast surgery/cancer/lumps/biopsies History of rape, abuse

Infertility Surgeries Therapeutic/elective pregnancy

terminations History of STIs Cervical pathology

Homework #1: Based on this diagram, develop your concept mapon 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.

Screening Rh factor, antibody screen Sexually transmitted infections HIV Cervical cancer

Diagnostic To confirm presence of disease

Prepare patient and environment Obtain consent to be examined Ongoing interaction General assessment Nutritional assessment Abdominal palpation

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

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.

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.

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.

Use gentle but deep pressure Fetal back is smooth, hard, and resistant

surfaceKnees and elbows of fetus feel with a number of angular nodulation

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.

Purpose◦ To determine the degree of flexion of fetal head.◦ To determine attitude or habitus.

ProcedureFacing foot part of the woman, palpate fetal head pressing downward.Use both hands.

120 to 160 beats per minute Fetoscope Doppler ultrasound stethoscope Electronic fetal monitoring for high-risk

pregnancies Non-stress test

Maternal weight gain/edema Blood pressure Urine Uterine growth Fetal heart tones Fetal movements and presentation

Nurse’s role◦ Heighten public awareness◦ Empower women/families to reduce unwanted

pregnancies◦ Advocate for responsible sexual behavior

Impact on society

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.

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)