NURS 2866 - Week 3 Lab Packet

What detailed subjective and objective history questions should the nurse ask during Anne’s first prenatal visit to assess pregnancy status and risks?

Date of last menstrual period (LMP); menstrual history (cycle regularity and length); sexual history and contraception use; symptoms (nausea, vomiting, breast tenderness, fatigue, urinary frequency); presence of vaginal bleeding or cramping; past pregnancies and miscarriage details; medical history, medications, allergies; substance use (alcohol, drugs, smoking); social support, safety, and financial situation; history of STIs or recent infections such as UTI

What comprehensive physical and clinical assessments are expected during the first prenatal visit?

Full health history; vital signs; height and weight to calculate BMI; pelvic exam; breast exam; baseline laboratory testing (blood and urine); STI screening; confirmation of pregnancy via hCG testing

How is the estimated due date (EDD) calculated using Naegele’s Rule for an LMP of 2/6/24?

Add 7 days (Feb 13), subtract 3 months → November 13, 2024

What is Anne’s GTPAL based on one prior miscarriage at 8 weeks and current pregnancy?

G2 T0 P0 A1 L0

What specific tests are included in a standard prenatal laboratory panel?

Blood type and Rh factor; CBC (hemoglobin/hematocrit); rubella immunity; hepatitis B (HBsAg); syphilis (RPR/VDRL); HIV (ELISA); hCG level; urinalysis; STI screening (chlamydia/gonorrhea)

What additional diagnostic tests may be performed during the first prenatal visit beyond the standard lab panel?

Pap smear if due; ultrasound for dating/viability; optional genetic screening; urine culture

What findings are most likely shown in early pregnancy QR images during first trimester assessment?

Positive pregnancy test or early ultrasound showing gestational sac; cervical changes such as Chadwick’s sign (bluish discoloration) or Goodell’s sign (soft cervix)

What are the presumptive (subjective) signs of pregnancy that Anne is experiencing?

Nausea and vomiting; breast tenderness; urinary frequency; fatigue; amenorrhea

What are the probable (objective) signs of pregnancy that can be identified by the provider?

Positive pregnancy test (hCG); cervical softening (Goodell’s sign); uterine enlargement; Chadwick’s sign (bluish cervix)

What conditions can mimic early pregnancy symptoms and must be considered in differential diagnosis?

Urinary tract infection (UTI); hormonal imbalance; gastrointestinal illness; stress; ovarian cysts

How is fetal well-being assessed during the first trimester?

Ultrasound to detect fetal heartbeat and development; monitoring hCG levels for appropriate rise

What are the priority education topics for a patient in the first trimester of pregnancy?

Prenatal vitamins (especially folic acid); proper nutrition; avoidance of alcohol and drugs; management of nausea; warning signs (bleeding, severe pain); importance of STI treatment

What key follow-up questions should the nurse ask during a second trimester prenatal visit?

Presence of fetal movement (quickening); pain such as round ligament pain; vaginal bleeding or abnormal discharge; nutrition and weight gain; sleep disturbances; heartburn; medication adherence; STI treatment follow-up

What assessments are routinely performed during a second trimester prenatal visit?

Vital signs; weight gain monitoring; fundal height measurement; fetal heart tones; edema assessment

What laboratory test is expected between 24–28 weeks gestation and why is it important?

Glucose screening test to assess for gestational diabetes

What are the positive (diagnostic) signs of pregnancy in the second trimester?

Fetal heart tones heard by Doppler; fetal movement palpated by examiner; ultrasound visualization of fetus

What complications should the nurse educate Anne to monitor for during the second trimester?

Preterm labor; gestational diabetes; preeclampsia; infections such as untreated STIs

Why does Anne require Rhogam during pregnancy and when is it administered?

She is Rh negative (B-), so Rhogam is given at 28 weeks to prevent Rh sensitization and hemolytic disease of the newborn

What important assessment questions should the nurse ask during a third trimester prenatal visit?

Headache or vision changes (preeclampsia signs); swelling of face or hands; fetal movement patterns; contractions; sleep or breathing difficulty; vaginal bleeding or leaking of fluid

What is the clinical significance of a blood pressure reading of 145/90 in pregnancy?

Indicates hypertension and raises concern for preeclampsia

What maneuver is used by the provider to determine fetal position, presentation, and size?

Leopold’s maneuvers

What are the priority education topics for a patient in the third trimester?

Signs of preeclampsia (headache, vision changes, swelling); daily kick counts; when to go to the hospital (labor signs); iron intake for anemia (Hgb 9.0); left-side positioning to improve circulation

What are the common clinical reasons for performing an ultrasound during pregnancy?

Assess fetal growth; determine fetal position; locate placenta; evaluate amniotic fluid volume; detect fetal anomalies

What are the five components of a biophysical profile (BPP) and what do they assess?

Fetal breathing movements; fetal movement; fetal tone; amniotic fluid volume; nonstress test (NST)

What are the potential complications associated with amniocentesis?

Infection; bleeding; preterm labor; miscarriage; fetal injury

What is the high-yield summary of priorities across all three trimesters of pregnancy?

First trimester focuses on pregnancy confirmation and baseline labs; second trimester focuses on fetal growth, glucose screening, and Rhogam administration; third trimester focuses on monitoring for preeclampsia and ensuring fetal well-being