Exemplar: Pre-conception and Antepartum

what is preconception?

the period before a pregnancy is conceived, but some patient are not trying to conceive and some are looking to conceive in the near future

what is antepartum?

the period of pregnancy before childbirth

what is going on during preconception?

• general reproductive and sexual health of patient (and partner as needed)

• preparation to conceive OR contraception

what is going on during antepartum?

• confirmation of pregnancy

• health of both patient and fetus (and family)

• education/anticipatory guidance

• screening for and treating alterations (complications)

What are the questions being asked during preconception?

• what are my patient’s goals?

• what is the reason for the patient’s visit?

• what chronic conditions do i need to keep in mind?

• What medical history may impact the patient’s goal and/or my nursing care?

• what medications does my patient take?

• any alcohol consumption?

what are the questions being asked during antepartum?

• how far along in pregnancy is the patient?

• what are my patient’s goals?

• how is the patient physically and emotionally adjusting to pregnancy and symptoms?

• is the fetus growing and developing as expected

• what screening is recommended at this stage?

• what do i need to educate my patient on?

How does endocrine change the body in pregnancy?

• HCG = pregnancy hormone (embryo implant in uterus)

• estrogen = lining building, hyper-coagulability (increases builds + thickens lining of uterus)

• Progesterone = lining support (increase prevents contractions - creates nutrients

How does Respiratory change the body in pregnancy?

• increased O2 demand (increase metabolism)

• SOB r/t progesterone causing hyperventilation and/or uterine enlargement (uterus pushes on diaphragm)

How does cardiovascular change the body in pregnancy?

• increased volume, CO, HR (increase stroke volume - increase volume d/t baby)

• Risk for elevated BP (increases when uterus puts pressure on inferior vena cava)

• LE stasis = risk for DVT (hormones changes → more prone to clotting and as uterus gets bigger causing venous return when putting pressure on inferior vena cava)

How does musculoskeletal change the body in pregnancy?

• balance of weight as baby grows = back pain (weight gain)

• loosening of ligaments especially in pelvis

How does psychosocial change the body in pregnancy?

• role changes (increase family size, wk prego)

• decision making (choice birth)

How does skin change the body in pregnancy?

• hyperpigmentation (increase estrogen and progesterone)

• striae (stretch marks, uterus growth, and skin elasticity)

How does GU change the body in pregnancy?

• urinary frequency (baby presses on bladder)

• uterine enlargement (growing baby)

• breast changes (hormonal changes, prep for breast feeding)

• pause in menstrual cycle (hormones stop lining of uterus to shed)

How does GI change the body in pregnancy?

• N/V (hormones: Hcg

• constipation (increase progesterone, decrease peristalsis, decrease fluids and movement)

• acid reflux (LEs relaxation, decrease opening of duodenal sphincter

what are changes that can connect with nursing concepts?

• perfusion

• pain/comfort

• clotting

• oxygenation

• fluid balance

• stress and coping

• metabolism

• nutrition

• sexuality

what is the overall goals for preconception assessments?

• support reproductive health of patient

  • considering chronic conditions

• support reproductive health of partner as needed

• prepare to conceive

• establish contraception plan

what do we actually assess for preconception?

• general medical history (sexual, obstetric, family, vaccination history)

• social history (patient safety and culture/religion)

• mental health status. (stress and coping)

• nutrition and exercise (don’t start, but continue what you have been doing)

• substance use (any alcohol, caffeine, marijuana, illicit drugs, etc)

• current medication list (everything they are taking like herbs and supplements

• head to toe physical assessment

what are the new goals for antepartum?

• confirm pregnancy (don’t assume its a good thing)

• assess patient’s plan and support system

• monitor growth and development of fetus

• monitor patient’s health status and adaptation to pregnancy

• Screen for and follow any alterations → high risk (preexisting conditions (cancer, hypertension, overweight, heart disease, organ disfunction), age (under 17 or over 35), )more than 1 baby

what do we actually assess for antepartum?

• signs of pregnancy (subjective, objective, diagnostic OR presumptive, probable, positive)

• dating of pregnancy - Nagele’s Rule

• Patient feedback regarding fetal movement (kick count)

• patient head to toe physical assessments

• patient experience and symptoms in pregnancy

• fetal and patient diagnostic tests

• education regarding pregnancy and newborns

it’s important to?

double check documentation with your site

Do not discuss OB history?

in front of a partner or support person

what is gravidity?

# of times pregnant

what is parity?

# of births

what are the main alterations?

• nausea and vomiting

• ectopic pregancy

what to know about nausea and vomiting?

• often happens in first trimester likely due to increase in hCG (in morning)

• monitor capillary refill

what to know about ectopic pregnancy?

• when the pregnancy implants outside of the uterus (most commonly in the fallopian tube

• Sx: one sided severe pain (even if it comes and goes)

• Tx:methotrexate (chemo) if early on, surgery to remove embryo if it has developed move

• can be life threatening (d/t internal bleeding) if not treated on time

what are other examples of alterations?

• gestational diabetes

• deep vein thrombosis

• vaginal bleeding

• spontaneous abortion

• Rh alloimmunization

• group B strep infection

• anemia

• folic acid insufficiency