Antepartal Nursing Assessment PDF

Antepartal Nursing Assessment CHAP.9 Ø Antepartum : time between conception and the onset of labor ; prenatal Ø Intrapartum : time from the onset of true labor until the birth of the baby and placenta Ø Postpartum : time from the delivery of the placenta and membranes until the woma...

Antepartal Nursing Assessment CHAP.9 Ø Antepartum : time between conception and the onset of labor ; prenatal Ø Intrapartum : time from the onset of true labor until the birth of the baby and placenta Ø Postpartum : time from the delivery of the placenta and membranes until the woman’s body returns to a nonpregnant condition; typically about 6 weeks Ø Gestation : the number of weeks of pregnancy since the first day of the last menstrual period Ø Abortion : birth that occurs before the end of 20 weeks’ gestation or the birth of a fetus-newborn who weighs less than 500 g Ø Stillbirth : a baby born dead after 20 weeks’ gestation Ø Term : normal duration of pregnancy Ø Full term : births occurring between 39 weeks 0 days and 40 weeks 6 days Ø Postterm : births occurring after 42 Ø Preterm labor : labor that occurs after 20 weeks’ gestation but before completion of 36 weeks’ gestation Ø Postterm labor : labor that occurs after 42 weeks’ gestation Ø Gravida : any pregnancy, regardless of duration, including present pregnancy. abbreviated as G. Ø Nulligravida : a woman who has never been pregnant Ø Primigravida : a woman who is pregnant for the first time Ø Multigravida : a woman who is in her second or any subsequent pregnancy Ø Para : birth after 20 weeks’ gestation regardless of whether the baby is born alive or dead. abbreviated as P. Ø Nullipara : a woman who has had no births at more than 20 weeks’ gestation Ø Primipara : a woman who has had one birth at more than 20 weeks’ gestation regardless of whether the baby was born alive or dead  Multipara : a woman who has had two or more births at more than 20 weeks’ gestation TPAL T: number of early, full, or late term births the woman has experienced (number of babies born at the 37 weeks’ gestation) P: number of preterm births (births after 20 weeks’ gestation but before 37 weeks’ gestation, whether living or stillborn) A: number of pregnancies ending in either spontaneous or therapeutic abortion (before 20 weeks’ gestation) L: number of currently living children to whom the woman has given birth ‫رللأل هتذجأل نيذلألاايحأدا لافطألا ددع‬  Prenatal‫أ‬History Details of current pregnancy – First day of last normal menstrual period (LMP) (Is she sure of the dates or uncertain? Do her cycles normally occur every 28 days, or do her cycles tend to be longer?) – Presence of cramping, bleeding, or spotting since LMP – Woman’s opinion about the time when conception occurred and when baby is due – Woman’s attitude toward pregnancy (Is this pregnancy planned? Wanted?) – Results of pregnancy tests, if completed Any discomforts since LMP such as nausea, vomiting, urinary frequency, fatigue, or breast tenderness  Prenatal‫أ‬History History of past pregnancies – Number of pregnancies – Number of abortions, spontaneous or induced Number of living children History of previous pregnancies, length of pregnancy, labor and birth, type of birth (vaginal, or cesarean), location of birth, type of anesthesia used woman’s perception of the experience, – Neonatal status of previous children: Apgar scores, birth weights, general development, complications, and feeding patterns (breast milk, formula, or both). If breastfed, for how long? – Loss of a child (miscarriage, elective or medically indicated abortion, stillbirth, neonatal death). Cause of loss – Blood type and Rh factor – Prenatal education classes and resources  Prenatal‫أ‬History Gynecologic history – Date of last (Pap) smear; result? – Previous infections: vaginal, cervical, pelvic inflammatory disease (PID), or sexually transmitted infections (STIs) – Previous surgery (uterine, ovarian) Age at menarche Regularity, frequency, and duration of menstrual flow – History of dysmenorrhea – History of infertility – Contraceptive history – Any issues related to infertility or fertility treatments  Current medical history Weight ,height, body mass index (BMI) General health, including nutrition (dietary practices such as vegetarianism; lactose intolerance; food allergies?) regular exercise program (type, frequency, and duration)‫أ‬ monthly breast self-examination; eye examination; date of last dental examination medications presently being taken Previous or present use of alcohol, tobacco, or caffeine Illicit drug use or abuse ‫ايذهشألا غلدلوأداأايذهيفذأل ادعأخيدأ يدارت‬ Drug allergies and other allergies ( Potential teratogenic insults to this pregnancy ( viral infections, medications, x-ray ,surgery, or cats ) Presence of chronic disease illnesses since LMP (flu, measles) Record of immunizations (especially rubella); up to  Past medical history Childhood diseases Past treatment ,Any hospitalizations? Major injuries?) Surgical procedures Presence of bleeding disorders or tendencies (Has she received blood transfusions? Will she accept blood transfusions?) Family medical history Presence of diabetes, cardiovascular disease, cancer, hypertension, Occurrence of multiple births‫أ‬ History of congenital diseases or deformities Occurrence of cesarean births and cause, if known  Genetic history Birth defects Recurrent pregnancy loss Stillbirth Down syndrome,‫أ‬ Genetic disorders (cystic fibrosis, sickle cell disease/trait, muscular dystrophy). Religious, spiritual, and cultural history Does the woman wish to specify a religious preference on her medical record? Does she have any spiritual beliefs or practices that might influence her health care or that of her child e.g receiving blood products, dietary considerations, or circumcision rites? ‫جأاليفذأداأ يا للوأداأ ذدلذوأدانيتأولأاي دأرتاأدرذيافذألا نيتأداأدرذيتأهتتفذأ جأات شأ يا ذوألالطأداأ‬ ‫لارالذدلوألاوالةيتأداأه ااألاغاذحا‬  Current medical history – Presence of disease conditions such as diabetes – Immunizations (especially rubella) – Presence of any abnormal symptoms – Occupational history – Occupation Physical demands e.g Does she stand all day – Exposure to chemicals or other harmful substances – Opportunity for regular meals and breaks for nutritious snacks – Provision for maternity or family leave‫االيدأأ ذمعأل ا تأداأل لدع‬ – Father’s history – Age – Significant health problems – Blood type and Rh factor – Presence of genetic conditions or diseases in him or in his family history – Occupation – Educational level – Current tobacco use, drug use, and alcohol intake – Thoughts/feelings about the pregnancy  Personal history Age Educational level Housing; stability of living conditions; neighborhood safety; animals in the home ‫ألمذحأةأللا دلدألا دالألا ييييتأةألي تألانشألانيالاذوألشألا امج‬ Economic level Any history of emotional or physical deprivation‫ ند ذح‬or abuse of herself or children History of emotional/mental health problems e.g depression in general, postpartum depression, anxiety Support systems Personal favorites about the birth Feeding preference for the baby (Breast milk or formula?) Prenatal Risk-Factor Screening ‫ةد لوما ما رط لا ماوع ص‬ Risk factors are any findings that suggest a negative outcome for either the woman or her unborn child. Screening for risk factors is an important part of the prenatal assessment. Many risk factors can be identified during the initial assessment or during subsequent visits Any pregnancy may begin as low risk and change to high risk because of complications Table 9–1 Prenatal High-Risk Factors/ important page 550  Initial Prenatal Assessment qConsider physical, cultural, and psychosocial factors that influence her health. qEstablish nurse-client relationship qDiscuss religious or spiritual, cultural, or socioeconomic factors qHistory qprepare the woman for the physical examination(vital signs; woman’s body, pelvic examination).‫أ‬ qAsk woman to provide a clean urine specimen before the examination- empty bladder is more comfortable‫ل‬ qAssessment Guide: Initial Prenatal Assessment / important.  Determination of Due Date “due date,” or the date around which childbirth estimated date of birth (EDB) Nägele’s rule may be accurate determiner of the EDB if the woman has a history of menses every 28 days, remembers her LMP, and was not taking oral contraceptives before becoming pregnant ovulation occurs 14 days before the onset of the next menses, not 14 days after the previous menses – Begin with the first day of the LMP‫لللدألذاياطأل اجأ حألالادعأ‬ – Subtract 3 months OR add 9 month , and add 7 days  First day of LMP November 21 Subtract 3 months − 3 months August 21 Add 7 days + 7 days EDB (of the next year) August 28 It is simpler to change the months to numeric terms: November 21 becomes 11–21 Subtract 3 months −3 months 8–21 Add 7 days + 7 days EDB (of the next year) 8–28  Uterine Assessment /Physical Examination –‫أ‬ Fundal height: Measurement of uterine size ü Distance in centimeters from the top of the symphysis pubis to the top of the uterine fundus ü Fundal height in centimeters correlates well with weeks of gestation between 22 and 34 weeks ü If woman is very tall or very short, fundal height will differ ü Should be measured by the same examiner each time ü Woman should have voided, same position each time ü Third trimester, variations in fetal weight decrease the accuracy of FH  Assessment of Fetal Development Quickening: Fetal movements felt by the mother, called quickening, may indicate that the fetus is nearing 20 weeks’ gestation may be experienced between 16 and 22 weeks’ gestation‫أ‬ Fetal Heartbeat:‫أ‬ vultrasonic Doppler device: fetal heartbeat at 8 to 12 weeks’ gestation v110 to 160 beats/min. Ultrasound: vearly pregnancy: Transvaginal ultrasound‫أ‬ vafter about 10 weeks, transabdominal ultrasound Method used to measure fetal parts va gestational sac as early as 5 weeks after the LMP, vfetal heart activity by 6 to 7 weeks, vfetal breathing movements by 10 to 11 weeks of pregnancy. EDB‫أ‬Wheel Fetal‫أ‬Position‫أ‬When‫أ‬McDonald’s‫أ‬Method‫أ‬Used  ssessment of Pelvic Adequacy (Clinical Pelvimetry)‫أ‬ The pelvis can be assessed vaginally to determine whether its size is adequate for a vaginal birth Pelvic inlet ‫ماةود‬ ‫ا‬ Diagonal conjugate (the distance from the lower posterior border of the symphysis pubis to the sacral promontory): at least 11.5 cm Obstetric conjugate (a measurement approximately 1.5 cm (0.60 in.) smaller than the diagonal conjugate): 10.0 cm (3.9 in.) or more Pelvic outlet Anteroposterior diameter: 9.5 to 11.5 cm (3.75 to 4.5 in.) Transverse diameter (bi-ischial or intertuberous diameter): 8 to 10 cm (3.15 to 3.9 in.)  Basic‫أ‬Screening‫أ‬Tests Pap smear U/A Complete blood count Rubella titer ABO and Rh typing Hepatitis B screen Syphilis and gonorrhea screening  Other‫أ‬Tests Drug screen HIV testing Sickle cell screen Cystic fibrosis screen Screen for chromosomal anomolies and neural tube defects 1-hr 50g GTT at 24-28 weeks Group B strep test at 35 to 37 weeks  Subsequent Client History Adjustment of the support person and of other children family Preparations: the family has made for the new baby Discomfort, kinds of discomfort Physical changes that relate directly to the pregnancy, such as fetal movement Exposure to contagious illnesses Medical treatments and therapies prescribed for nonpregnancy problems since the last visit Consumption of prescription or over-the-counter medications or herbal supplements Use of complementary and alternative therapies Danger signs of pregnancy Danger‫أ‬Signs‫أ‬of‫أ‬Pregnancy ‫ري ذوألاغهدأرتاألان ج‬  Subsequent‫أ‬Prenatal‫أ‬Assessment The recommended frequency of antepartum visits in an uncomplicated pregnancy is as follows Every 4 weeks for the first 28 weeks’ gestation Every 2 weeks from 28 weeks’ until 36 weeks’ gestation After week 36, every week until childbirth For psychological problems, provide ongoing support and counseling  Subsequent‫أ‬Prenatal‫أ‬Assessment Assessments during prenatal visits.‫أ‬ – Vital signs and weight – Edema – Uterine size and fetal heartbeat – Urinalysis – Blood tests for AFP, glucose – Vaginal swab for group B strep – Expected psychological stage of pregnancy. – Assessment Guide Subsequent Prenatal Assessment  Assessment Guide Subsequent Prenatal Assessment/ important Normal‫أ‬Physiologic‫أ‬Changes Pulse may increase by 10 beats per minute Respiration may be increased and thoracic breathing predominant Temperature and blood pressure within normal limits  Normal Physiologic Changes Weight varies: Should be proportional to the gestational age of the fetus Nose: Nasal stuffiness Chest and lungs: Transverse diameter greater than anterior-posterior diameter Skin: – Linea nigra‫أ‬ – Striae gravidarum – Spider nevi Mouth: Gingival hypertrophy Neck: Slight hyperplasia of thyroid in the third trimester – small, nontender nodes  Normal‫أ‬Physiologic‫أ‬Changes Breasts – Increasing size – Pigmentation of nipples and areola – Colostrum appears in third trimester Abdomen – Progressive enlargement – Fetal heart rate heard at approximately 12 weeks’ gestation Extremities: Possible edema late in pregnancy Spine: Lumbar spinal curve may be accentuated  Normal‫أ‬Physiologic‫أ‬Changes Pelvic area: Vagina without significant discharge Cervix closed Uterus shows progressive growth Laboratory tests – Physiologic anemia may occur (decrease in hemoglobin and hematocrit) – Small degree of glycosuria may occur