Antepartum (prenatal care)

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Antepartum (prenatal care)
2011-11-28 11:20:01
Antepartum prenatal care

Antepartum (prenatal care)
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  1. Prenatal visits
    Scheduled every month for 7 Months, every 2 weeks during the eighth month, and every week during the last month
  2. Prenatal visits (initial prenatal visit)
    Determine estimated date of delivey based on the last menstrual period

    a vaginal ultrasound may be done to establish the estamated date of delivery

    obtain medical and nursing history to include: past medical health, family history, social supports, and review of systems (to determine risk factors), and past obstetrical history

    perform a physical assessment to include a patients baseline weight, vital signs, and pelvic examination. Have the patient empty her bladder before the exam.

    obtain initial laboratory work to induce blood type, Rh factor (blood test), HIV status (patient has the right to refuse), hepatitis B, venereal disease research laboratory (VDRL), rubella status, urinalysis, and papanicolaou test (PAP). A indirect Coomb's test will determine if a patient is sensitized to Rh-positive blood
  3. Ongoing prenatal visits include
    Monitoring weight, blood pressure, and urine for glucose, protein, and leukocytes

    Monitor a patient for the presence of edema

    Monitor fetal development

    FHR can be heard by doppler at 10-12 weeks of gestation or heard with an ultrasound stethoscope at 16-20 weeks of gestation

    listen at the midline, right above the symphysis pubis, by holding the stethoscope firmly on the abdomen

    start measuring fundal height after 12 weeks of gestation

    between 18-30 weeks of gestation, the fundal height measured in centimeters should equal the week of gestation. (example; 22 weeks should be 22cm ect...)

    Have the patient empty her bladder and measure from the level of the symphysis pubis to the upper border of the fundus

    • begin assessing for fetal movement berween 16-20 weeks of gestation
  4. Education during the prenatal visits includes
    self-care: ways to manage common discomforts and concerns of pregnancy (nausea and vomiting, fatigue, backache, varicosities, heartbun, activity, sexuality)

    • health promotion
    • preparation for pregnancy and birth
    • common discomforts of pregnancy
    • danger signs to report

    avoid all over the counter medications, supplements, and prescriptive medications unless the obstetrician who is supervising her care has knowledge of them

    • alcohol (birth defects)
    • tobacco (low birth weight)
    • substance abuse of any kind should be avoided during pregnancy and during lactation

    • encourage:
    • patient ro receive a flu vaccine during the fall months

    smoking cessation

    treat current infections

    obtain genetic testing and provide counseling

    ascertain meternal exposure to hazardous materials

    avoid the use of hot tubs and saunas

    consume at least 2-3 L of water each day from food and beverage sources
  5. administer Rho(D) immune globulin (RhoGAM)

    around 28 weeks of gestation for patients who are Rh negative
  6. Exersize during pregnancy
    should consist of 30 min of moderate exercise (walking, swimming) daily if not medically or obstetrically contraindicated
  7. Emotional Lability
    experienced by many women with unpredictable mood changes and increased irritability, tearfulness, and anger alternating with feelings of joy and cheerfulness

    this all may result from profound hormonal changes
  8. ambivalence (about the pregnancy)
    this is normal may occur early in the pregnancy resolving before the third trimester

    it consists of conflicting feelings (joy, pleasure, sorrow, hostility) about the pregnancy. These feelings can occur simultaneously whether the pregnancy was planned or not
  9. Teaching in the first trimester
    physical and pshchosocial changes

    common discomforts of pregnancy and measures to provide relief

    lifestyle exersize/stress/nutrition, sex, dental care, over-the-counter and prescription medications, tabacco, alcohol, substance abuse (discuss strategies to decrease or discontinue use), STD's (encourage safe sex practices)

    possable complications and signs to report

    fetal growth and development

    prenatal exercise

    expected laboratory testing
  10. Teaching in the second trimester
    benefits of breastfeeding

    common discomforts and relief measures

    lifestyle sex and pregnancy/rest and relaxation/posture/body mechanics/clothing/seat-belt safety/ and travel

    fetal movement

    complications (preterm labor, gestational hypertension, geatational diabetes mellitus, premature rupture of membranes)

    childbirth preparation
  11. Teaching in the third trimester
    • Childbirth:
    • childbirth classes or birth plan

    breathing and relaxation techniques (deep cleansing breaths at one-half the usual respiratory rate during contractions can promote relaxation of the abdominal muscles, which lessens the discomfort of uterine contractions)

    discussion regarding pain management during labor and birth (natural childbirth/epidural)

    signs and symptoms of preterm labor and labor

    labor process

    infant care

    postpartum care
  12. Fetal movement/kick counts
    instruct patient ot count and record fetal movements or kicks daily

    count fetal activity 2 or 3 times a day for 60 min each time.

    fetal movements of less than 3 in/hr or movements that cease entirely for 12 hrs indicate a need for further evaluation

    diagnostic testing for fetal well-being (nonstress test, biophysical profile, ultrasound and contraction stress test)