Chapter 09 narrated

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Chapter 9 : 

Chapter 9 The Prenatal Assessment

Prenatal Period : 

Prenatal Period Maternal reactions Ambivalence Maternal self-preservation World Health Report “Make Every Woman and Every Child Count” Prenatal care Societal support of pregnant women

CAREing for the Patient : 

CAREing for the Patient Nurse’s role Communicate Advocate Empower women Help woman become informed recipient of care Facilitate shared decision-making

Stress and Pregnancy : 

Stress and Pregnancy Nurse’s role Focus on communication, personalized care, education Provide support Offer stress management techniques Gain woman’s confidence

Healthy People 2010 : 

Healthy People 2010 Access to care Barriers to service Health insurance Health provider barriers System barriers Social disparities

The First Prenatal Visit : 

The First Prenatal Visit

Nurse’s Role—First Prenatal Visit : 

Nurse’s Role—First 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

Comprehensive Health History : 

Comprehensive Health History Biographical data Social history—intimate partner violence and drug use Psychological assessment Obstetric history Current pregnancy

Signs and Symptoms of Pregnancy : 

Signs and Symptoms of Pregnancy Presumptive Amenorrhea Nausea/vomiting Urinary frequency Breast tenderness Probable Piskacek sign Hegar sign Chadwick sign

Pregnancy Tests : 

Pregnancy Tests

Positive Signs of Pregnancy : 

Positive Signs of Pregnancy Fetal heartbeat Fetal movements Visualization of fetus

Estimated date of birth (EDB) : 

Estimated date of birth (EDB) Naegele’s rule History Intercourse/signs and symptoms Date of last normal menstrual period Date of positive home pregnancy test

Pregnancy Classification System : 

Pregnancy Classification System Gravid/gravida/gravidity Nulligravida Primigravida Multigravida Parity GTPAL classification system

Medical History : 

Medical History Medical conditions Dental health Eye health Immunizations Hepatitis B infection Environmental hazards

Gynecological History : 

Gynecological History DES exposure Breast surgery/cancer/lumps/biopsies History of rape, abuse

Gynecological History : 

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

Screening and Diagnostic Tests : 

Screening and Diagnostic Tests Screening Rh factor, antibody screen Sexually transmitted infections HIV Cervical cancer Diagnostic To confirm presence of disease

Prenatal Physical Examination : 

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

Focused Obstetrical Examination : 

Focused Obstetrical Examination Head, neck, lungs Skin Breasts Abdomen Uterine size, fetal position, fundal height Vagina and pelvis

Leopold Maneuvers : 

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

Fetal Heart Auscultation : 

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

Subsequent Prenatal Examinations : 

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

Assessing Special Populations : 

Assessing Special Populations

Teenage Pregnancy : 

Teenage Pregnancy Nurse’s role Heighten public awareness Empower women/families to reduce unwanted pregnancies Advocate for responsible sexual behavior Impact on society

Teenage Pregnancy : 

Teenage Pregnancy Cultural influences Identifying adolescents at risk Impact on developmental tasks Delayed entry into care

Nursing Care of Pregnant Adolescent : 

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

The Older Gravida: Considerations in Pregnancy : 

The Older Gravida: Considerations in Pregnancy Identify chronic medical conditions Identify detrimental lifestyle habits Physical examination: focus on breasts and circulatory problems Offer screening for fetal chromosomal abnormalities