Assessment of the Pregnant Woman (3) PDF

ASSESSING CHILDBEARING WOMEN HEALTH ASSESSMENT PROPERTY OF SUSAN L. ARNOLD, RN, MSN, ACUE  COMPLEX AND CHALLENGING STAGE OF A WOMAN’S LIFE THAT AFFECTS: EVERY ANATOMIC SYSTEM; PREGNANT WOMEN EXPERIENCE PROFOUND ANATOMI...

ASSESSING CHILDBEARING WOMEN HEALTH ASSESSMENT PROPERTY OF SUSAN L. ARNOLD, RN, MSN, ACUE  COMPLEX AND CHALLENGING STAGE OF A WOMAN’S LIFE THAT AFFECTS: EVERY ANATOMIC SYSTEM; PREGNANT WOMEN EXPERIENCE PROFOUND ANATOMICAL AND OVERVIEW PHYSIOLOGICAL CHANGES IN OF NEARLY EVERY ORGAN SYSTEM OF THE BODY. MOST OF THESE PREGNANC CHANGES ARE INFLUENCED BY Y THE HORMONES OF PREGNANCY; ESTROGEN AND PROGESTERONE PSYCHOSOCIAL/EMOTIONAL STATUS NUTRITIONAL STATE  SIGNS/SYMPTOMS OF EARLY PREGNANCY PRESUMPTIVE PROBABLE AMENORRHEA ABDOMINAL ENLARGEMENT BREAST TENDERNESS PISKACEK’S SIGN (ASYMMETRY OF UTERUS) FATIGUE HEGAR’S SIGN (SOFTENING OF NAUSEA/VOMITING LOWER UTERINE SEGMENT) FREQUENT URINATION GODDELL’S SIGN (SOFTENING OF CERVIX) CHADWICK’S SIGN (BLUE COLORATION OF THE VULVA/CERVIX BRAXTON-HICKS CONTRACTIONS (PAINLESS, IRREGULAR, INTERMITTENT UTERINE CONTRACTIONS) POSITIVE SIGNS/SYMPTOMS OF EARLY PREGNANCY FETAL HEART SOUNDS DETECTED BY DOPPLER QUICKENING (FETAL MOVEMENT FELT BY 19 TO 20 WEEKS) VISUALIZATION OF FETUS BY ULTRASOUND  DIAGNOSTICS THE FOLLOWING ARE USED TO CONFIRM PREGNANCY: URINE PREGNANCY TEST (HCG) SERUM QUALITATIVE TEST (HCG) SERUM QUANTITATIVE TEST (HCG) ULTRASOUND  DIAGNOSTICS ROUTINE SERUM SCREENING GENETIC TESTING (NONINVASIVE OR INVASIVE) CERVICAL CANCER SCREENING CHLAMYDIA/GONORRHEA/HIV/SYPHILIS SCREENING URINALYSIS/URINE CULTURE GESTATIONAL DIABETES VAGINAL/PERIANAL CULTURES FOR GROUP B STREPTOCOCCUS  SKIN, HAIR, AND NAILS STRIAE GRAVIDARUM (STRETCH MARKS) – BREASTS, ABDOMEN, THIGHS, AND BUTTOCKS HYPERPIGMENTATION – LINEA NIGRA ON ABDOMEN, CHLOASMA (DARKENING OF SKIN ON THE FACE (“MASK OF PREGNANCY”) ACNE MAY GET BETTER OR WORSE HIRSUTISM OF THE FACE, ABDOMEN, AND BACK MOUTH, THROAT, NOSE, SINUS, AND EARS GINGIVAL BLEEDING VOCAL CHANGES D/T EDEMA OF LARYNX NASAL STUFFINESS AND EPISTAXIS D/T EDEMA AND VASCULAR CONGESTION OF THE NASAL MUCOSA AND SINUSES DECREASE IN SENSE OF HEARING, SENSE OF FULLNESS IN THE EARS AND EARACHES D/T INCREASED VASCULARITY OF THE TYMPANIC MEMBRANE AND BLOCKAGE OF EUSTACHIAN TUBES  THORAX AND LUNGS INCREASED ANTEROPOSTERIOR AND TRANSVERSE DIAMETERS SHORTNESS OF BREATH DURING THE LAST TRIMESTER OXYGEN REQUIREMENTS INCREASE D/T ADDITIONAL CELLULAR GROWTH OF MOTHER AND FETUS PULMONARY REQUIREMENTS INCREASE ESTROGENIC EFFECTS ALLOW INCREASED CHEST EXPANSION FOR ADEQUATE OXYGENATION AND CAPILLARY ENLARGEMENT TIDAL VOLUME INCREASES BY 30% TO 40% BECAUSE OF INCREASED PROGESTERONE; ENABLES INCREASED DEPTH OF BREATHING  HEART HEART SIZE INCREASES BECAUSE IT MUST PUMP MUCH HARDER BLOOD VOLUME IS INCREASED BY 40% TO 50% HEART RATE MAY INCREASE 10 TO 15 BEATS/MINUTE FIBRINOLYTIC (CLOTTING) ACTIVITY IS SUPPRESSED PROVIDING PROTECTION AGAINST HEMORRHAGE DURING DELIVERY AND POSTPARTUM. PREGNANT WOMEN HAVE AN INCREASED RISK OF THROMBOSIS DUE TO CHANGES IN COAGULATION (CLOTTING) ACTIVITY.  PERIPHERAL VASCULAR PERIPHERAL VASCULAR RESISTANCE DECLINES RESULTING IN DECREASED DIASTOLIC BLOOD PRESSURE IN THE FIRST AND SECOND TRIMESTER BUT RETURNS TO NORMAL IN THE THIRD TRIMESTER INCREASE IN MATERNAL BLOOD VOLUME PHYSIOLOGIC ANEMIA D/T THE DISPROPORTIONATE INCREASE IN BLOOD VOLUME COMPARED WITH THE INCREASED RED BLOOD CELL (RBC) PRODUCTION C/O DIZZINESS BEGINNING IN THE SECOND TRIMESTER DEPENDENT EDEMA AND VARICOSITIES INCREASED RISK FOR THROMBOPHLEBITIS  GASTROINTESTINAL AND RENAL SYSTEM INCREASED LEVELS OF HCG OR ESTROGEN RESULT IN NAUSEA & VOMITING IN THE FIRST TRIMESTER INCREASED PROGESTERONE AND PRESSURE FROM THE ENLARGING UTERUS RESULTS IN DECREASED MOTILITY WHICH CAN CAUSE ACID REFLUX AND ALSO INCREASED WATER ABSORPTION FROM THE COLON RESULTING IN CONSTIPATION URETERS DILATE RESULTING IN INCREASED URINE RETENTION WHICH CAN RESULT IN AN INCREASED RISK FOR UTI’S INCREASED BLADDER SENSITIVITY RESULTS IN FREQUENT URINATION OF SMALL AMOUNTS; LATER IN PREGNANCY THE BLADDER BECOMES COMPRESSED BY THE EXPANDING UTERUS CAUSING URGENCY DIASTASIS RECTI HEMORRHOIDS  MUSCULOSKELETAL UTERUS GROWTH PULLS THE PELVIS FORWARD WHICH CAUSES THE SPINE TO CURVE FORWARD; LORDOSIS ENLARGING BREASTS CAUSE THE SHOULDERS TO DROOP FORWARD WADDLING GAIT CENTER OF GRAVITY AND STANCE CHANGE, THE WOMAN LEANS BACKWARD SLIGHTLY TO BALANCE; BACKACHES ARE COMMON  NEUROLOGIC DIZZINESS PAIN, TINGLING, AND CRAMPS IN THE LEGS CARPAL TUNNEL SYNDROME D/T FLUID RETENTION  PSYCHOSOCIAL EMOTIONAL CHANGES ARE NORMAL AS WOMEN ADJUST TO LIFE CHANGES AROUND CHILDBEARING ANXIETY, DEPRESSION, OR MOOD CHANGES ARE NORMAL WOMEN WITH UNDERLYING MENTAL ILLNESS MAY IMPROVE OR WORSEN BECAUSE A WOMAN'S BODY AND MIND GOES THROUGH SO MANY CHANGES AFTER DELIVERY, “POSTPARTUM BLUES” OR “BABY BLUES” OR FEELINGS OF SADNESS ARE COMMON FOLLOWING DELIVERY; USUALLY GO AWAY IN 3 TO 5 DAYS PERSISTENT FEELINGS OF DEPRESSION OR ANXIETY MAY INDICATE MORE SERIOUS PROBLEMS  POSTPARTUM DEPRESSION MAY BE CAUSED BY HORMONAL CHANGES AND THE MANY PHYSICAL, EMOTIONAL, AND SOCIAL STRESSORS THAT GO ALONG WITH BEING A NEW MOTHER PERSISTENT FEELINGS OF DEPRESSION OR ANXIETY MAY INDICATE MORE SERIOUS PROBLEMS POSTPARTUM DEPRESSION IS A SERIOUS CONDITION THAT CAN BE LIFE-THREATENING. WOMAN MAY HAVE FEELINGS OF HARMING THEMSELVES OR THEIR CHILDREN.  POSTPARTUM DEPRESSION SIGNS & SYMPTOMS: FATIGUE, INSOMNIA, MOOD CHANGES, DEPRESSION LACK OF INTEREST IN THE NEWBORN, DIMINISHED ABILITY TO THINK OR FOCUS SIGNS & SYMPTOMS THAT MAY BE POTENTIAL FOR ABUSE: MOTHER UNABLE TO CARE FOR SELF OR BABY MOTHER AFRAID TO BE ALONE WITH THE BABY MOTHER HAS NEGATIVE FEELINGS OR THOUGHTS OF HARMING THE BABY UNEXPLAINED BRUISES AND INJURIES TO BABY  REVIEW OF SYSTEMS THE CHALLENGE OF A REVIEW OF SYSTEMS FOR A PREGNANT WOMAN IS TO DIFFERENTIATE NORMAL AND EXPECTED CHANGES FROM ABNORMAL OR CONCERNING PROBLEMS. IMPORTANT TO GET BASELINE DATA ABOUT THE MOTHER AND HER PARTNER TO IDENTIFY RISK FACTORS USE THE COLDSPA MNEMONIC TO IDENTIFY ATTRIBUTES OF A SYMPTOM.  FETAL WELL-BEING MOVEMENT PERCEIVED AS TYPICAL FOR PREGNANCY SIGNS/SYMPTOMS OF LABOR FREQUENT, PAINFUL CONSISTENT CONTRACTIONS, PELVIC OR LOW BACK PAIN VAGINAL BLEEDING LEAKING OF FLUID FROM VAGINA CULTURAL CONSIDERATIONS PRENATAL CARE IN THE UNITED STATES FOLLOWS A PRESCRIBED PLAN WITH INTERVAL VISITS STARTING IN THE FIRST TRIMESTER. THIS MODEL OF CARE MAY SEEM FOREIGN TO WOMEN OF OTHER CULTURES WHERE PRENATAL CARE MAY BE DELIVERED IN THE HOME, INFREQUENTLY, OR NOT AT ALL.  PREGNANCY DISCOMFORTS NAUSEA/VOMITING SHORTNESS OF BREATH FOOD AVERSIONS BREAST REFLUX TENDERNESS/ENLARGE MENT CONSTIPATION SLEEP CHANGES HEART RACING MOOD CHANGES HEART SKIPPING A BEAT LIBIDO CHANGES FATIGUE  VITAL SIGNS VITAL SIGNS ARE ASSESSED AT EACH PRENATAL VISIT. MEASUREMENT OF BP IS ONE OF THE MOST IMPORTANT ASPECTS OF PRENATAL CARE BP DECREASES DURING THE SECOND TRIMESTER BECAUSE OF THE RELAXATION OF THE BLOOD VESSELS BUT THEN RETURNS TO NORMAL BY 32-34 WEEKS PULSE MAY INCREASE 10 TO 15 BEATS/MINUTE PREGNANT WOMEN MAY DEVELOP PREGNANCY-INDUCED HYPERTENSION WHICH MAY INDICATE A POTENTIALLY LIFE-THREATENING ILLNESS KNOWN AS PRE-ECLAMPSIA  MEASURING HEIGHT AND WEIGHT PURPOSE: TO PROVIDE BASELINE INFORMATION; TO ENSURE ADEQUATE CALORIC INTAKE REQUIRED FOR HEALTHY MAINTENANCE OF PREGNANCY AND IF THERE IS A SUDDEN INCREASE MAY BE D/T FLUID RETENTION AND INCREASED BP HEIGHT IS ASSESSED AT THE FIRST PRENATAL VISIT. WEIGHT IS ASSESSED AT EACH VISIT. EXPECTED WEIGHT GAIN IS 2-4 LBS. DURING THE FIRST TRIMESTER AND 11 TO 12 LBS. IN THE SECOND AND THIRD TRIMESTER FOR A TOTAL WEIGHT GAIN OF 25 TO 35 LBS.  ASSESSING WEIGHT NORMAL FINDINGS ABNORMAL FINDINGS WEIGHT GAIN OF 25-35 LBS WEIGHT GAIN LESS THAN FOR WOMEN WITH NORMAL 15 LBS OR GREATER THAN BMI AT START OF PREGNANCY. 35LBS DURING THE COURSE OF THE PREGNANCY  HEALTHY PEOPLE 2030 GOALS INCREASE THE PROPORTION OF WOMEN WHO RECEIVE PRENATAL CARE IN THE FIRST TRIMESTER INCREASE THE PROPORTION OF WOMEN DELIVERING A LIVE BIRTH WHO RECEIVED PRECONCEPTION CARE SERVICES AND PRACTICED KEY RECOMMENDED PRECONCEPTION HEALTH BEHAVIORS. IMPROVE PREGNANCY PLANNING AND SPACING AND PREVENT UNINTENDED PREGNANCY. INCREASE ABSTINENCE FROM ALCOHOL, CIGARETTES, AND ILLICIT DRUGS AMONG PREGNANT WOMEN. HEALTHY PEOPLE 2030 GOALS REDUCE CESAREAN BIRTHS AMONG LOW-RISK (FULL- TERM, SINGLETON, VERTEX PRESENTATION) WOMEN. REDUCE PRETERM BIRTHS  QUESTION WHICH SYMPTOM OF EARLY PREGNANCY INDICATES A NEED FOR CAREFUL FOLLOW UP AND MONITORING? A. NAUSEA B. SHORTNESS OF BREATH C. CONSTIPATION D. INCREASED URINATION  ANSWER CORRECT ANSWER: B SHORTNESS OF BREATH IS NOT COMMON IN EARLY PREGNANCY AND MAY INDICATE AN UNDERLYING RESPIRATORY OR CARDIAC PROBLEM.  QUESTION WHICH OF THE FOLLOWING ARE PRESUMPTIVE SIGNS/SYMPTOMS OF PREGNANCY? A. AMENORRHEA B. FATIGUE C. ABDOMINAL ENLARGEMENT D. INCREASED URINATION  ANSWER CORRECT ANSWER: A, B, D ABDOMINAL ENLARGEMENT IS A PROBABLE SIGN/SYMPTOM OF PREGNANCY.