OB ATI: Chapter 4 - Prenatal Care

OB ATI: Chapter 4 - Prenatal Care Prenatal care involves - nursing assessments and client education for expectant mothers. - When providing prenatal care, nurses must take into account cultural considerations. Prenatal education encompasses information provided to a client who is pregnant. Major areas of focus include assisting the client in - self-care of the discomforts of pregnancy, promoting a safe outcome to pregnancy, and fostering positive feelings by the pregnant woman and her family regarding the childbearing experience. Prenatal care dramatically reduces infant and maternal - morbidity and mortality rates by early detection and treatment of potential problems. - A majority of birth defects occur between 2 and 8 weeks of gestation. Nursing assessment in prenatal care includes obtaining information regarding: - ◯ Reproductive and obstetrical history (contraception use, gynecological diagnoses, and obstetrical difficulties). ◯ Medical history, including the woman's immune status (rubella and hepatitis B). ◯ Family history, such as genetic disorders. ◯ Any recent or current illnesses or infections. ◯ Current medications, including substance use and alcohol consumption. ◯ Psychosocial history (a client's emotional response to pregnancy, adolescent pregnancy, spouse, support system, history of depression, domestic violence issues). ◯ Any hazardous environmental exposures; current work conditions. ◯ Current exercise and diet habits as well as lifestyle. Prenatal care begins with an - initial assessment and continues throughout pregnancy. - In an uneventful pregnancy, prenatal visits are scheduled monthly for 7 months, every 2 weeks during the eighth month, and every week during the last month. At the initial prenatal visit: - ■ Determine estimated date of birth based on the last menstrual period. ■ Obtain medical and nursing history to include social supports, and review of systems (to determine risk factors). ■ Perform a physical assessment to include a client's baseline weight, vital signs, and pelvic examination. Assess for costovertebral angle tenderness to identify kidney infection. ■ Obtain initial laboratory tests. Ongoing prenatal visits include the following: - ■ Monitoring weight, blood pressure, and urine for glucose, protein, and leukocytes. ■ Monitoring for the presence of edema. ■ Monitoring fetal development. FHR can be heard by Doppler at 10 to 12 weeks of gestation or heard with an ultrasound stethoscope at 16 to 20 weeks of gestation. Listen at the midline, right above the symphysis pubis, by holding the stethoscope firmly on the abdomen. Measure fundal height after 12 weeks of gestation. Begin assessing for fetal movement between 16 and 20 weeks of gestation. ■ Providing education for self-care to include management of common discomforts and concerns of pregnancy (nausea and vomiting, fatigue, backache, varicosities, heartburn, activity, sexuality). Prenatal care/Routine Lab Tests: Blood type, Rh factor - › Determines the risk for maternal-fetal blood incompatibility (erythroblastosis fetalis) or neonatal hyperbilirubinemia. Prenatal care/Routine Lab Tests: CbC with differential, hgb, and hct - › Detects infection and anemia. Prenatal care/Routine Lab Tests: hgb electrophoresis - › Identifies hemoglobinopathies (sickle cell anemia and thalassemia). Prenatal care/Routine Lab Tests: Rubella titer - › Determines immunity to rubella. Prenatal care/Routine Lab Tests: hepatitis b screen - › Identifies carriers of hepatitis B. Prenatal care/Routine Lab Tests: group b streptococcus (gbs) - › Obtained at 35 to 37 weeks of gestation. Prenatal care/Routine Lab Tests: urinalysis with microscopic examination of ph, specific gravity, color, sediment, protein, glucose, albumin, RbCs, wbCs, casts, acetone, and human chorionic gonadotropin - › Identifies pregnancy, diabetes mellitus, gestational hypertension, renal disease, and infection. Prenatal care/Routine Lab Tests: one-hour glucose tolerance (oral ingestion or iV administration of concentrated glucose with venous sample taken 1 hr later [fasting not necessary]) - › Identifies hyperglycemia; done at initial visit for at-risk clients, and at 24 to 28 weeks of gestation for all pregnant women ( 140 mg/dL requires follow up). Prenatal care/Routine Lab Tests: three-hour glucose tolerance (fasting overnight prior to oral ingestion or iV administration of concentrated glucose with a venous sample taken 1, 2, and 3 hr later) - › Used in clients with elevated 1-hr glucose test as a screening tool for diabetes mellitus. A diagnosis of gestational diabetes requires two elevated blood-glucose readings. ....................