Care Of Mother, Child, And Adolescent: Prenatal Assessment PDF

ARDIENTE, ODAYAN, SANCHEZ C. Positive: “Yea, you’re definitely pregnant” CARE OF MOTHER, CHILD, AND Girl: NASALO Q B babe? Boy: Oo ata babe. CGURO ADOLESCENT: Prenatal Asse...

ARDIENTE, ODAYAN, SANCHEZ C. Positive: “Yea, you’re definitely pregnant” CARE OF MOTHER, CHILD, AND Girl: NASALO Q B babe? Boy: Oo ata babe. CGURO ADOLESCENT: Prenatal Assessment Preggy Ba U? Girl: Umg Buntis Me Demographic Data Fetal outline U Ultrasound Name Birthdate / Age Beating of fetal B Educational Status: to know how to effectively heart (audible) explain or communicate with the patient Examiner: Registered Occupation: financial status, habits, health hazards Movement felt Midwife, Registered Nurse, Marital Status: support system (father), financial M by the examiner Licensed Doctor support, physical, psychological, and emotional support Religion: contraindications and holistic care Ethnic Origin (same as religion) Health History Address: Health care access, environmental hazards, A. Past Medical and Surgical History and disease outbreaks or trends in area What are the diseases that can pose difficulty Contact Information: in cases of emergency; need of during pregnancy a decision Examples: Person to Contact in case of Emergency o Your client prior to being pregnant is diagnosed with hypertension o She has cardiac problems (gravidocardiac Chief Complaint patients) o Diagnosed with PCOS Last Menstrual Period: first day of your last menstrual period You also need to assess or ask about her childhood Pregnancy Test: “Nag-positive kasi ako kaya I’m here to diseases (teratogenic effects) seek for consultation.” Ask for allergies and drug sensitivities Signs and Symptoms: categorized into three: Ask for past surgeries and injuries (impending risk) Presumptive, Probable, and Positive B. History of Family Illnesses / Heredofamilial A. Presumptive: “You might be pregnant” Diseases Cardiovascular Nag sex ang dalawang mag partner, Renal Girl: NASALO Q B? Cognitive Impairment Blood disorders because of increasing level of nausea and human chorionic Genetically inherited diseases N Congenital anomalies vomiting gonadotropin (hCG) Absence or temporary C. Social History/ Day History A Amenorrhea cessation of menstruation Ask the patient’s age and partner’s age - Maturity Melasma (A.K.A: Chloasma, Women over 35 are in high risk for pregnancy, the “Mask of Pregnancy”): due to old age, the eggs are sensitive at least S Skin changes Birthmark like patches when the guy ejaculates. - Enlargement or Abdominal Educational Level growth Occupation - Linea Nigra (dark line Marital Status and availability of support people Abdominal from umbilicus to symphysis Size of Apartment: Smaller space = high risk for A changes pubis) communicable disease - Striae gravidarum (stretch marks) Nutritional Status - the quality of the mother’s diet Exercise: to know if mother is at risk for gestational Due to imbalance levels of diabetes which is a risk for the baby to have LGA Laging pagod or Large Gestational Age L estrogen and progesterone (fatigue) Hobbie: some hobbies may harm the baby Increased urinary pressure Smoking: Teratogenic effect and vasoconstriction (during first trimester) due to (constrict blood flow to the baby) leading for risk Overactive O fetal pressure towards bladder of SGA or Small Gestational Age bladder Excessive Alcohol Intake: can cause teratogenic Movement felt by the mother. effects - At presumptive state due Medication and use of herbal med: unhygienic Q Quickening to unknown cause by the and improper preparation may harm the baby mother Recreational drugs Partner abuse - Enlarged / Engorged - Darkening of the areolas B Breast changes and nipples NOTE: ▪ Teratogen: harmful to the baby ▪ Small for Gestational Age (SGA): Birth weight of less B. Probable: “It’s highly likely you’re pregnant” than 10th percentile for gestational age Girl: NASALO Q B babe? ▪ Large for Gestational Age (LGA): Refers to a fetus or Boy: Oo ata babe. CGURO Preggy Ba U? infant who is a larger than expected for their age and gender Bluish or purplish discoloration D. Gynecologic History C Chadwick’s sign of the cervix, vagina, and vulva Age of Menarche Menstrual Cycle, interval, duration, amount of Softening of Cervix due to flow, and any discomfort increased vascularization (4th – Monthly perineum self-examination G Goodell’s sign 8th week) Breast self-examination: 5-7 days after Softening of the cervical menstruation. Even at menopause. Uterine softening Surgery of the reproductive tract U isthmus (4th – 6th week) (Hegar’s sign) Reproductive planning method: to assess any Rebound of fetus complications. Sexual pills are good to prevent when tapped pregnancy but not for STI R (ballottement) Sexual history: Assess multiple partner (risk for STI) - Leopolds maneuver: Felt sign of fetal contour, but Assess for possibility of stress incontinence Outline by O can be tumor (not Palpation E. Obstetric History confirmed) Review past pregnancies Probable, not totally confirmed Determine OB score: varying degree of wound Positive (may be due to expired PT, healing P Pregnancy Test hormonal medicine, etc.) Determine the AOG Defined as the irregular, Identify the expected date of confinement (EDC) Braxton Hicks or expected date of delivery (EDD) B painless uterus contractions Contractions Age of the infant: during interview, ask for every Reveals presence of possible information regarding the first baby. U Ultrasound gestational sound Birth weight: to assess recurrency Maternal status Pregnancy is planned or not: Assess resources Note: Arranged alphabetically are: Chadwick’s Goodell’s Complications during pregnancy: Asess safety & Hegar’s (CGH). They are arranged accordingly: Vagina > Cervix > Uterus Medications taken Prenatal care and check-up: at least 4 pre-natal visits (DOH), Ideally every month. Duration of labor NOTES; DO NOT REPRODUCE ARDIENTE, ODAYAN, SANCHEZ Labor expectations Answer: 3-35-2023 or April 4, 2023 Type of Birth: normal or cesarian, forceps? vacuum? Fetal Presentation: cephalic or breech DETERMINING THE AGE OF GESTATION Birth Place: hospital, clinic, birthing home or NID Ultrasound: one of the most accurate ways to determine (non-institutional delivery) which means hindi the AOG since it measures the fetal head, abdomen, and umabot sa hospital, home deliveries: we do not thigh bone. advocate as this is one of the goals of SDG’s due to high rates of mortality. McDonald’s Rule (Fundic height): involves measuring Perineal Stiches the distance from the symphysis pubis to the uterine Complications following Childbirth: assess fundus. presence of postpartum bleeding, infection, or - This measurement in cm is equal to the week of depression gestation approximately Overall Pregnancy Status - Between 20 to 31st week. Previous Miscarriages or therapeutic abortions Steps in the McDonald’s Rule: RH compatibility Ask if she had any blood transfusion: assess risk 1. Measure fundic height in cm for STI or disease 2. If you want to know the AOG by weeks use this formula: - Fundic heigh in cm multiplied by 8 divided by 7 OB Scoring - If you want to know the AOG by months: fundic height in cm multiplied by 2 divided by 7 a. Gravida: number of pregnancies (born or unborn) b. Para or Parity: number of deliveries that reach the Age of Viability (20 weeks and beyond) c. Term: number of infants (37 weeks and above) DETERMINING THE AGE OF GESTATION IF LMP IS d. Preterm: number of infants (20 weeks to 36 6/7 KNOWN weeks) Steps: e. Abortion: less than 20 weeks or 19 6/7 weeks and less 1. Determine the LMP f. Living: currently living children 2. Compute for total number of days from LMP until the g. Multiple pregnancies: number of multiple pregnancies date that you would like to know the AOG (Twins = 1 lang ang count) If you want to determine the AOG by weeks: the total number of days divided by 7 If you want to determine the AOG by months: total Exercise number of days divided by 28 1. Kathy is pregnant for the 1st time Note: Lip years - Answer: G1 2. Kathy carried the pregnancy to term and neonate survived Bartholomew’s Rule of Fourths: depends on the height - Answer: G1P1 (1-0-0-1) of the fundus 12 weeks (3 months) – symphysis pubis 3. Kathy is pregnant again but unfortunately; she had a 10 weeks (4 months) – between symphysis pubis and miscarriage at 10 weeks umbilicus - Answer: G2P1 (1-0-1-1) 20 weeks (5 months) – umbilicus 24 weeks (6 months) – 2cm above umbilicus 4. Kathy is on her 3rd pregnancy and she gave birth at 28 weeks (7 months) - between umbilicus and xiphoid 36 weeks to a twins process - Answer: G3P2 (1-2-1-3-1) 32 weeks (8 months) – below xiphoid process 5. A pregnant woman who had the following past history: 36 weeks (9 months) – xiphoid process a boy born at 39 weeks gestation, now alive and 40 weeks (10 months) – below xiphoid process well Note: After 40 weeks, the height goes back at the level a girl born at 40 weeks gestation, now alive and of 32 weeks (below xyphoid process) due to the fetal well descent (lightening) near the cervix for delivery. a girl born at 33 weeks, now alive and well - Answer: G4P3 (2-1-0-3) Lightening: At the end of the third trimester, the fetus settles, or drops lower, into your pelvis. 6. Sara, a post-partum woman has the following OB history: 1st pregnancy: pregnancy terminated at 12 REVIEW OF SYMPTOMS (ROS) weeks AOG Part ng interview: done after assessment 2nd pregnancy: born at 39 weeks AOG, alive and well A. Head 3rd pregnancy: Presence of headache – note characteristic and - Answer: G4P3 (2-2-1-4-1) frequency Head injury 7. Mrs. Santos is on her 3rd pregnancy. Her 1st child who Seizure is now 5 y/o was born full term. She has a history of Dizziness miscarriage on 2nd pregnancy at 12 weeks AOG. She was admitted in the hospital in active labor. After 2 Fainting hours in labor, she delivered twins at 37 weeks. What is her OB score? B. Eyes - Answer: G3P2 (3-0-1-3-1) What is her vision (20/20) Is she wearing prescription glasses 8. The client is pregnant for the 4th time. Her 1st child Double vision was born at term. 2nd pregnancy ended 15 weeks Vision changes: due to pregnancy induced AOG. In her 3rd pregnancy, she gave birth to twins hypertension at 35 weeks and one of the twins died. Eye pain - Answer: G4P2 (1-2-1-2-1) Cataract Glaucoma Computation of EDD or EDC using LMP Eye discharges Noted eye infection a. April – December 1. Subtract 3 in months C. Ears 2. Add 7 in the days Ear pain 3. Add 1 to year Infection b. January – March (there are two ways): Vertigo Just count 3 months backward or D. Nose Add 9 months then add 7 days Colds - frequency Exercise! Allergies Sinusitis 1. Compute for the EDC OF Mrs. Tomas whose LMP was on April 2 to 7, 2022 E. Mouth and Pharynx - Months: April (4) – 3 = 1 - Day: 02 + 7 = 9 Dentures - Year: 2022 + 1 = 2023 Dental condition Tonsilitis: frequency Answer: 1-09-2023 or January 9, 2023 Gingivitis 2. LMP was May 1 to 5, 2022 Hoarseness of voice - Months: 5 – 3 = 2 Difficulty in swallowing - Days: 1 + 7 = 8 - Year: 2022 + 1 = 2023 F. Neck Answer: 2-08-2023 or February 8, 2023 Stiffness Mass 3. LMP was June 28 to July 2, 2022 Lumps - Months: 6 – 3 = 3 - Days: 28 + 7 = 35 G. Breast - Year: 2022 + 1 = 23 Lumps NOTES; DO NOT REPRODUCE ARDIENTE, ODAYAN, SANCHEZ Discharges Conception outside the uterus - woman is truly pregnant but need to be terminated H. Respiratory System Form in fallopian tube, cervix, ovaries, intestines, Chest pain – Cardio or respiratory related abdomen Difficulty in breathing d. Exogenous hCG production Wheezing (asthma) Outside source of hCG like medications Previous Tuberculosis Infection: pregnancy have e. Drugs high risk of reactivating TB. TB medicine only Drugs that alter results like aspirin or encapsulates the virus. carbamazepine (psychological drugs) I. Cardiovascular System Chest pain WHY THERE IS FALSE NEGATIVE? History ng Heart Murmur a. Early Measurement or Testing - test taken before History Hypertension 2-3 weeks of possible conception Anemia Blood disorders b. Diluted Urine History of blood transfusion Not enough concentration Should use first urine in the morning J. Gastrointestinal Ulcer c. Hook Effect Vomiting Excessively high hCG levels that can’t be detected by Constipation the test kit Hemorrhoids Molar pregnancy: egg and sperm join incorrectly at Diarrhea fertilization creating benign tumor (affects hCG levels) - multiple pregnancies: creates more amount K. Genitourinary System of hCG. UTI – female is more prone due to shorter urethra Hematuria LABORATORY TESTS Frequent urination – may be due to UTI History of STI LABORATORY TESTS PURPOSE/DETECTS Infection, Anemia, Cell Complete Blood Count L. Extremities Abnormalities Leg pain Hemoglobin/Hematocrit Anemia Stiffness an joints Blood Grouping, RH ABO Incompatibility, RH Varicose veins Factor, Antibody Screen incompatibility History of fracture or dislocation Venereal Disease Research Laboratory (VDRL) STIsSyphilis M. Skin test Rashes Rubella Titer Rubella Immunity Acne Tuberculin Skin Test Tuberculosis Discoloration (purified protein derivative) (1cc of tuberculin) Chromosomal Genetic Testing Abnormalities PHYSICAL ASSESSMENT Immunity, Reactive or Non- Hepatitis B Screening reactive 1. Vital Signs: (Pregnant) HIV screening HIV antibodies Urinalysis Urinary Tract Infection < 140/90 mmHg may indicate PIH BP Gestational Diabetes Glucose Challenge Test 60-100 bpm Mellitus (GDM) pre-pregnancy: 70 – 80 bpm Pulse Rubella Vaccine pregnant: 80 – 90 bpm live attenuated vaccine Increase by 1 – 2 bpm has weak forms of rubella RR teratogenic effect Slightly elevated temperature. cannot give vaccine to pregnant woman but advise to Temp - 36.6 – 37. 6 CBC Results of Pregnant Women: 30-50% increase in 2. Recommended Weight Gain blood volume diluting other blood components - Causing Physiologic Anemia/Pseudo anemia which is not a Ratio: 3-12-12 (lbs.) = 27 complication 1st Trimester: approx. 0.4kg (1lb) per month 2nd and 3rd Trimester: approx. 0.4kg PELVIC ULTRASOUND Exposing body part to high frequency sound waves (1lb) per week - kaya ang weight gain during pregnant is 3 to produce pictures of the inside of the body + 12 + 12 = 27 - kaya pag normal ang bmi mo bago ka mabuntis, 25-35 lbs ang inspected weight gain mo. Confirms pregnancy as early as 6 weeks AOG Detects problems i.e., abortion, ectopic pregnancy, placental previa, abruption placenta (premature separation of a normally implanted placenta), tumors Normal BMI Singleton Multipleton of pregnancy Underweight 28-24 > 18.5 Types of Pelvic Ultrasound Normal 25-35 37-54 1. Abdominal / transabdominal 18.5 – 24.9 - Supine position, better if in dorsal recumbent w/ Overweight pillow on side to avoid supine hypotension 25-29.9 15-25 31-50 - Transducer is applied on abdomen - Bladder preparation Obese < 30 11-20 25-42 a. full bladder preparation Morbidly obese - Less than 20 weeks < 40 - Abdomen is still small - Water to stabilize uterus - water enhances travel of sound waves - Instruct to have 1 glass of water every 15 PRENATAL ASSESSMENT minutes (6x) for 90 minutes empty bladder preparation (1.5l) 1. Pregnancy test b. Empty bladder preparation Detects presence of HCG in the blood or urine. - More than 20 weeks 2. Blood Serum hCG - Abdomen is big enough Trace amounts in the blood can be seen in 24 to - Instruct patient to void 48 hours after implantation Measurable level: 7-9 days from conception 2. Vaginal / transvaginal Peak level: 60th - 80th day of gestation that’s - Lithotomy position is advisable why nausea and vomiting is common on the first - Empty bladder preparation trimester (high levels of hCG) - Ky jelly for water-based lubricant - Transducer with condom Types of Blood Serum HCG a. Quantitative FETAL MOVEMENT b. Qualitative / Beta HCG Quickening: fetal movement felt by mother WHY THERE IS FALSE POSITIVE? from 16-20 weeks a. Blood or Protein in Urine: hCG is also a protein more evident at 28-38 weeks (3rd trimester) causing the test kit to recognize other proteins as hCG b. Human Error: wrong interpretation of the result Prima Gravida: 18-20 weeks (1st time pregnant) Multigravida: 16-18 weeks (more sensitive to changes) c. Ectopic hCG production NOTES; DO NOT REPRODUCE ARDIENTE, ODAYAN, SANCHEZ Methods in Monitoring Fetal Movement - can also get substances of AFP A. Sandovsky Method - will need to drain 15-20 ml of fluid Ask pt to count fetal movements for an hour after a meal To ensure that the fetus is awake for movement INDICATIONS FOR HIGH-RISK PREGNANCIES: Normally, at least 2 times evert 10 mins 35 years old and above: as women age, egg cells 10-12 times in an hour deteriorate in quality Family hx of congenital disabilities or genetic disorders B. Cardiff Method or Count to ten Abnormal results of prenatal screening tests Ask pt to record the time interval it takes for her Has a child with congenital disability or genetic to feel 10 fetal movements condition Normally within an hour or 60 minutes Doctor may recommend later in pregnancy in order to: If there are less than 10 fetal movements in an hour: STIMULATE! a. To check on lung development - check the ratio 1. Vibroacoustic Stimulation of lecithin and sphingomyelin - LS RATIO (2:1) Play music to wake baby up Phosphatidylcholine presence = lung mature 2. Give a high caloric drink and fetus is safe to deliver High calorie=high energy Healthy juice (orange or mango) b. Treat polyhydramnios (therapeutic) Excess volume of amniotic fluid - pushes the diaphragm upward, compressing the lungs = FETAL HEART TONES DOB - relieve pressure and shortness Of breath for comfort Assess to check fetal well-being Using stethoscope, fetoscope, doppler, fetal monitor c. Test for anemia and treat while the baby is inside - Doppler: heard at 10-12 weeks the abdomen - Stethoscope: heard at 18-20 weeks AMNIOCENTESIS PROCEDURE FETAL HEART RATE 1) Reinforce physician’s EP and rationale a. Normal: 120-160 bpm (110-160) Reinforce questions nurse can answer b. Moderate Bradycardia: 100-119 bpm 2) Witness signing of informed consent c. Marked Bradycardia: 99 or less Doctor’s job to secure pt consent (will do Late sign of fetal distress procedure) After a period of tachycardia, heart rate slows 3) Bladder preparation down Depends on the AOG d. Moderate Tachycardia: 161-179 bpm 4) Prepare equipment and supplies: e. Marked Tachycardia: 180 and above Gauge 20-22 spinal needle with stylet Early sign of fetal distress - heart compensates for 10- and 20-ml syringes lack of oxygen and other complications 3 ml test tubes covered with tape External Fetal Monitor Dressing and adhesive tape (for puncture) Sensor one = detect FHT / FHR 5) Obtain baseline maternal VS and FHT/FHR Sensor two = detect uterine contractions Notice changes in vital signs 6) Supine position Doppler 7) Assist with real time ultrasound - Most common assessing FHR/FHT 8) Drape 9) Provide abdominal prep (iodine solution) - Utz waves on mother's abdomen 10) Assist the MD and anticipate patient needs - 10 - 12 weeks of pregnancy 11) Provide emotional support - Non- invasive POST AMMIOCENTESIS PROCEDURE CARE DIAGNOSTIC TESTS TO ASSESS THE FETAL 1) Apply pressure and dressing on the site of aspiration WELLBEING 2) Obtain test tubes from the MD, label, and send to the lab 3) Advise a client in the 2nd half o pregnancy to rest on A. Maternal Serum Alpha-Fetoprotein (MSAFP) her left side AFP is a glycoprotein produced by the fetal liver 4) Observe closely for 30-40 mins: Reaches a peak in maternal serum a. PHR every 15 mins (blood) between 13 - 32 weeks b. VS every 15 mins - palpate the fundus for fetal Mostly done at the 15th week activity or uterine contractions (may result to preterm labor) 5) Reassure that mild cramping may be present AFP LEVELS INTERPRETATION 6) Instruct the pt to report the presence of a) High ↑: spinal cord up to brain = neural tube a. Vaginal discharge (bleeding/drainage) defects (spina bifida, meningocele, b. Altered fetal mobility - severe uterine cramping or myelomeningocele) abdominal pain High levels should be made sure if caused by c. Any signs of infection multiple pregnancies 7) Advise to avoid the following within 24 hours: - b) Low ↓: down = Down Syndrome strenuous activities Note: ↑ AOG = ↑ AFP Heavy lifting Sexual intercourse B. Chorionic Villi Sampling (CVS) PERCUTANCOUS UMBILICAL BLOOD SAMPLING Part of the placenta collected through fine Aka cordocentesis needle aspiration (invasive) Diagnostic genetic test that examines blood from the Retrieval and analysis of chorionic villi for fetal vein of the umbilical cord to detect: chromosome or dna analysis - reveals genetic - Chromosomal abnormalities disorder - Blood disorders 8-10 weeks of pregnancy - Metabolic disorders Risk for bleeding is less than 1% - Infections Not common in the Philippines - Some causes of structural problems Note: should inform parents about possible limb reduction - Procedure lasts for 7 minutes syndrome or phocomelia - Performed no earlier than 17 weeks - Miscarriage occurs in 1-2% of procedures Amelia: absence of extremities - May get posteriorly or anteriorly Phocomelia: putol/deformed limbs Types of CVS (both utz guided) 1) Transvaginal (speculum + catheter) 2) Transabdominal (biopsy needle) C. Amniocentesis Amnio(amniotic) centesis (puncture) Performed after the 14th week because the amniotic fluid volume is about 200 ml which is safe to drain out (15-20 weeks) withdrawal of amniotic fluid through abdominal and uterine wall to determine: - fetal health - lung maturity (3rd trimester usually) - inborn errors of metabolism - chromosomal abnormalities - CNS disorders - sex of fetus (XX, XY chromosomes) - neural tube defects NOTES; DO NOT REPRODUCE