ATI OB Study guide
Maternal Child Health Nursing (Rasmussen University)
Initial Prenatal Visit: ↑
Estimated date of delivery based on LMP. Vaginal ultrasound may be done to establish DOD
Medical & nursing history including past med health, family history, social supports, social
history, & review of systems (to determine risk factors) & past OB history
Physical assessment: baseline weight, vitals, pelvic exam
Initial lab work:
o Blood type
o RH factor
o HIV status
o Hep B
o VDRL
o Rubella status
o Urinalysis
o Pap
o Indirect Coomb’s test will determine if client is sensitized to RH+ blood
Ongoing Prenatal Visits:
Monitor weight, BP, & urine for glucose, protein, & leukocytes
Present of edema
Fetal development:
o FHR heard by Doppler at 10-12 weeks
o Heard with ultrasound stethoscope at 16-20 wks. Listen at the midline, right above the symphysis
pubis, holding stethoscope firmly on abdomen
o Measure fundal height after 12 wks. Between 18 & 30 weeks, fundal height measured in cm should
equal the week of gestation. Have pt empty bladder & measure from the level of the symphysis pubis to
the upper border of the fundus
o Begin assessing for fetal movement between 16 & 20 weeks gestation
, Routine Lab Tests in Prenatal Care & Their Purpose
Blood type, Rh factor, presence of irregular Determines risk for maternal-fetal blood
antibodies incompatibility (erythroblastosis fetalis) or
neonatal hyperbilirubinemia.
For clients are are Rh(-) & not sensitized, the
indirect Coombs’ test will be repeated b/t 24-28
weeks gestation
CBC w/ differential, Hgb, Hct Detects infection & anemia
Hgb electrophoresis Identifies hemoglobinopathies (sickle cell anemia
& thalassemia)
Urinalysis: pH, gravity, color, sediment, protein, Identifies DM, gestational HTN, renal disease, &
glucose, albumin, RBCs, WBCs, casts, acetone, & infection
HCG
1 hr Glucose Tolerance Identifies hyperglycemia; done at initial visit for at-
risk clients, & at 24-28 wks for all pregnant women
(oral/IV admin of concentrated glucose w/ venous
sample taken 1 hr later. Fasting not necessary) (>140 requires follow up)
3 hr Glucose Tolerance Used in clients w/ elevated 1-hr glucose tst as a
screening tool for DM.
(fasting overnight prior to oral or IV admin of
concentrated glucose with a venous sample taken A dx of GD requires 2 elevated blood-glucose
at 1, 2, & 3 hrs later) readings
Pap Test Screens for cervical cancer, HSV II, &/or HPV
Vaginal/Cervical Culture Detects streptococcus B-hemolytic, Group B
(routinely done at 35-37 wks), BV, STDS
(gonorrhea, chlamydia)
Rubella Titer Determines immunity to rubella.
If non-immune, give shot!
PPD, chest screening after 20 weeks w/ + purified Identifies exposure to TB
protein derivative
Hep B Screen Identifies carriers of hep B
VDRL Syphilis screening mandated by law
HIV Detects HIV infection: recommended for all clients
, who are pregnant unless client refuses testing
TORCH (Toxoplasmosis, other infections, rubella, Screening for group of infections capable of
cytomegalovirus, & herpes) when indicated crossing the placenta & adversely affecting fetal
development
Maternal serum alpha-fetoprotein (MSAFP) Between 15-22 wks
Rhogam Administration:
IM around 28 weeks for clients who are Rh (-)
For amniocentesis, car wreck, or any instance of possibility of fetal/maternal blood mixture
Health Promotion:
Avoid all OTC meds, supplements, & rx meds unless OB who is supervising care has knowledge of
this practice
Alcohol (birth defects) & tobacco (low birth weight) contraindicated during pregnancy
Substance abuse of any kind is to be avoid during pregnancy & lactation
Encourage flu vaccine during the fall months
Treat current infections
Ascertain maternal exposure to hazardous materials
Avoid use of hot tubs/saunas
Consume at least 2-3 L of h20 daily from food & beverage sources
Exercise: moderate exercise (walking/swimming) consisting of 30 minutes; no new exercise
during pregnancy
Third Trimester Childbirth Prep:
Breathing & relaxation techniques
o Deep cleansing breaths at ½ the usual respiratory rate during contraction can promote
relaxation of the abdominal muscles, which lessens the discomfort of uterine contraction.
discussion regarding pain management during labor & birth (natural child birth, epidural)
Fetal movement/kick counts to ascertain fetal well-being. Client should be instructed to count &
record fetal movements or kicks daily
, o It is recommended that mothers count fetal activity 2-3 x/day for 60 mins each time
o Fetal movements <3/hr or movements that cease entirely for 12 hours need further eval
Common Discomforts During Pregnancy:
Morning sickness: eat cracker or dry toast ½ to 1 hr before rising in the morning to prevent
discomfort. Avoid an empty stomach & drink fluids between meals.
UTIs are common due to renal changes & vaginal flora becoming more alkaline
o Wipe front to back, avoid bubble baths, wear cotton panties, avoid tight-fitting pants, &
consume 8 glasses of water/day
o Urinate as soon as urge occurs
Constipation may occur during 2nd & 3rd trimesters. Drink plenty of fluids, eat a diet high in fiber,
exercise regularly
Leg cramps may occur during 3rd trimester d/c compression of lower extremity nerves & blood
vessels by the enlarging uterus
o Homan’s sign should be checked
o If negative, patient should extend the affected leg, keeping knee straight & dorsiflexing the
foot (toes toward the head)
o Massaging & applying heat over affected muscle or a foot massage while the leg is extended
can help relieve cramping
o Notify PCP if frequent cramping occurs
Varicose veins & extremity edema during 2nd & 3rd trimesters
o Rest w/ legs elevated
o Avoid constricting clothing
o Wear support hose
o Avoid sitting or standing in one position for long periods of time
o Avoid sitting w/ legs crossed at knees
o Sleep in left lateral position
o Gingivitis, nasal stuffiness, & epistaxis can occur
Maternal Child Health Nursing (Rasmussen University)
Initial Prenatal Visit: ↑
Estimated date of delivery based on LMP. Vaginal ultrasound may be done to establish DOD
Medical & nursing history including past med health, family history, social supports, social
history, & review of systems (to determine risk factors) & past OB history
Physical assessment: baseline weight, vitals, pelvic exam
Initial lab work:
o Blood type
o RH factor
o HIV status
o Hep B
o VDRL
o Rubella status
o Urinalysis
o Pap
o Indirect Coomb’s test will determine if client is sensitized to RH+ blood
Ongoing Prenatal Visits:
Monitor weight, BP, & urine for glucose, protein, & leukocytes
Present of edema
Fetal development:
o FHR heard by Doppler at 10-12 weeks
o Heard with ultrasound stethoscope at 16-20 wks. Listen at the midline, right above the symphysis
pubis, holding stethoscope firmly on abdomen
o Measure fundal height after 12 wks. Between 18 & 30 weeks, fundal height measured in cm should
equal the week of gestation. Have pt empty bladder & measure from the level of the symphysis pubis to
the upper border of the fundus
o Begin assessing for fetal movement between 16 & 20 weeks gestation
, Routine Lab Tests in Prenatal Care & Their Purpose
Blood type, Rh factor, presence of irregular Determines risk for maternal-fetal blood
antibodies incompatibility (erythroblastosis fetalis) or
neonatal hyperbilirubinemia.
For clients are are Rh(-) & not sensitized, the
indirect Coombs’ test will be repeated b/t 24-28
weeks gestation
CBC w/ differential, Hgb, Hct Detects infection & anemia
Hgb electrophoresis Identifies hemoglobinopathies (sickle cell anemia
& thalassemia)
Urinalysis: pH, gravity, color, sediment, protein, Identifies DM, gestational HTN, renal disease, &
glucose, albumin, RBCs, WBCs, casts, acetone, & infection
HCG
1 hr Glucose Tolerance Identifies hyperglycemia; done at initial visit for at-
risk clients, & at 24-28 wks for all pregnant women
(oral/IV admin of concentrated glucose w/ venous
sample taken 1 hr later. Fasting not necessary) (>140 requires follow up)
3 hr Glucose Tolerance Used in clients w/ elevated 1-hr glucose tst as a
screening tool for DM.
(fasting overnight prior to oral or IV admin of
concentrated glucose with a venous sample taken A dx of GD requires 2 elevated blood-glucose
at 1, 2, & 3 hrs later) readings
Pap Test Screens for cervical cancer, HSV II, &/or HPV
Vaginal/Cervical Culture Detects streptococcus B-hemolytic, Group B
(routinely done at 35-37 wks), BV, STDS
(gonorrhea, chlamydia)
Rubella Titer Determines immunity to rubella.
If non-immune, give shot!
PPD, chest screening after 20 weeks w/ + purified Identifies exposure to TB
protein derivative
Hep B Screen Identifies carriers of hep B
VDRL Syphilis screening mandated by law
HIV Detects HIV infection: recommended for all clients
, who are pregnant unless client refuses testing
TORCH (Toxoplasmosis, other infections, rubella, Screening for group of infections capable of
cytomegalovirus, & herpes) when indicated crossing the placenta & adversely affecting fetal
development
Maternal serum alpha-fetoprotein (MSAFP) Between 15-22 wks
Rhogam Administration:
IM around 28 weeks for clients who are Rh (-)
For amniocentesis, car wreck, or any instance of possibility of fetal/maternal blood mixture
Health Promotion:
Avoid all OTC meds, supplements, & rx meds unless OB who is supervising care has knowledge of
this practice
Alcohol (birth defects) & tobacco (low birth weight) contraindicated during pregnancy
Substance abuse of any kind is to be avoid during pregnancy & lactation
Encourage flu vaccine during the fall months
Treat current infections
Ascertain maternal exposure to hazardous materials
Avoid use of hot tubs/saunas
Consume at least 2-3 L of h20 daily from food & beverage sources
Exercise: moderate exercise (walking/swimming) consisting of 30 minutes; no new exercise
during pregnancy
Third Trimester Childbirth Prep:
Breathing & relaxation techniques
o Deep cleansing breaths at ½ the usual respiratory rate during contraction can promote
relaxation of the abdominal muscles, which lessens the discomfort of uterine contraction.
discussion regarding pain management during labor & birth (natural child birth, epidural)
Fetal movement/kick counts to ascertain fetal well-being. Client should be instructed to count &
record fetal movements or kicks daily
, o It is recommended that mothers count fetal activity 2-3 x/day for 60 mins each time
o Fetal movements <3/hr or movements that cease entirely for 12 hours need further eval
Common Discomforts During Pregnancy:
Morning sickness: eat cracker or dry toast ½ to 1 hr before rising in the morning to prevent
discomfort. Avoid an empty stomach & drink fluids between meals.
UTIs are common due to renal changes & vaginal flora becoming more alkaline
o Wipe front to back, avoid bubble baths, wear cotton panties, avoid tight-fitting pants, &
consume 8 glasses of water/day
o Urinate as soon as urge occurs
Constipation may occur during 2nd & 3rd trimesters. Drink plenty of fluids, eat a diet high in fiber,
exercise regularly
Leg cramps may occur during 3rd trimester d/c compression of lower extremity nerves & blood
vessels by the enlarging uterus
o Homan’s sign should be checked
o If negative, patient should extend the affected leg, keeping knee straight & dorsiflexing the
foot (toes toward the head)
o Massaging & applying heat over affected muscle or a foot massage while the leg is extended
can help relieve cramping
o Notify PCP if frequent cramping occurs
Varicose veins & extremity edema during 2nd & 3rd trimesters
o Rest w/ legs elevated
o Avoid constricting clothing
o Wear support hose
o Avoid sitting or standing in one position for long periods of time
o Avoid sitting w/ legs crossed at knees
o Sleep in left lateral position
o Gingivitis, nasal stuffiness, & epistaxis can occur
