102A: week 1

what are Dx for an initial pregnant assessment *suspicion of pregnancy

-amenorrhea, home pregnancy, ABD US, transvaginal US *really early in pregnancy

what includes within in initial prenatal assessment

-personal info, pt/partner & fam medical hx

-current medical status and cultural, religious or spiritual hx

Physical exam - pelvic exam during prenatal care

-lithotomy position, visualize external genitalia/ vaginal canal/cervix

-Pap test, culture for STI, bimanual exam, assessment of pelvic bone

Assessment by trimester

1: confirmation, hx & labs, pelvic exam, basline VS

2: anatomy scan, fundal ht, fetal movement

3: GBS testing, fetal postion, kick counts & BP/ edema monitoring

what are some lab testing done for prenatal care

-CBC, antibody, rubella, varicella, hep B & C

-blood typing and Rh status *Rh- mom and Rh+ baby = Rhogam shot !

-Pap, TB, glucose challenge test & Group B streptococci test (GBS) *infection in vagina or rectum = r/f pneumonic or sepsis for baby

1st trimester diagnostic test for fetal health

PAPP-A: 11 to 13 wks to detect trisomy 18 & 21

NTT & CVS: genetic and chromosomal abnormalities

2nd trimester diagnostic test for fetal health

Amniocentesis (invasive): down syndrome, spina bifida

PUBS: cells obtained from umbilical cord

Quad screen: 15 to 20 wks to detect specific serum markers

Prenatal cell free DNA screening (NIPT)

blood test → analyzes fragments of fetal DNA, chromosomal abnormalities, sec of fetus & Rh blood type

*usually done after 10 wks

What is the frequency for visits & care for prenatal care

-monthly for the first 28 wks & every 2 wks until 36 wks gestation

-weekly after 36 wks until childbirth

Care for subsequent visits & care

-current wt, V/S & UA

-fundal ht, FHR, psychological assessment

-provide education, screen for intimate partner violence

What s/sx do you report & potential complications to provider

-vaginal bleeding and/or leaking, severe HA, blurry/impaired vision

-unusual or severe abd pain, excessive N/V/D

-swelling of feet, hands & face

patient centered care

-nearly every body system affected

-hormonal changes & fetal growth → physical discomforts

-seek guidance on maintaining health, promote self care & safety for mom/fetus

Promoting self care - Breast care

-bathe daily to keep breast clean

-colostrum may crust on nipple late in pregnancy

-avoid strong soaps to prevent dryness

-wear a supportive, well fitting bra

Promoting self care - Exercise

-helps prevent excess weight gain, support normal fetal growth

-decreased r/f gestational diabetes & pre- eclampsia

*stop & see HCP: dizziness, vaginal bleeding/leakage, chest pain, HA, ^SOB, decreased fetal movement

Lifestyle & safety considerations

travel- 2nd trimester is safest time but ambulate q2hrs & stay hydrate

dental- gums swell & may bleed easily

sexual activity - limit/ avoid when water breaks down/t risk of infection

what does TORCH stand for

Toxoplasma Others Rubella Cytomegalovirus Herpes

Toxoplasmosis & it is s/sx

from raw or undercooked meat or through exposure to cat feces

s/sx: body aches, HA, fatigue, sore throat

Toxoplasmosis complications

infants may develop chorioretinitis, obstructive hydrocephalus, seizures, motor delays

*can be present at birth or years after

Parvovirus B19 (under others)

causes 5th disease → erythema infectiousum

Varicella Zoster Virus (under others)

medical emergency in pregnancy

*educate pt to keep up with vaccinations

Measles Virus (under others)

severe consequences for pregnant women

HIV (under others)

major cause of infant & child mortality worldwide

Syphilis (under others)

can cause miscarriage, premature birth & stillbirth

West Nile virus (under others)

Transmitted by mosquitoes

Hepatitis (under others)

transmitted at time of delivery or during pregancy

Zika virus (under others)

Can cause severe congenital abnormalities

Rubella “German measles” transmitted by

-contact with respiratory secretions

- fetus is infected through placental transmission

Rubella “German measles” s/sx

-rash starting on face or neck

-enlarged lymph nodes, joint pain, fever, and cough

what are the 4 abnormalities for rubella

-deafness, CNS abnormalities, eye defects & cardiac malfunctions

Rubella “German measles” complications and pt education

-miscarriage, stillbirth, congenital rubella syndrome

pt education: report any rash or illness to HCP and avoid exposure

Cytomegalovirus (CMV) transmitted by… *herpes virus

-saliva, urine, other body fluids

-sexual contact, organ transplant, placenta & breast milk

Cytomegalovirus (CMV) s/sx for mother

-may be asymptomatic and may have fever, mild depression, muscle aches

Cytomegalovirus (CMV) complications

-IUGR (intra uterine growth restriction), microencephaly, hydrocephalus

-delayed motor development, hearing & vision loss

-seizures, rash

Herpes Simplex Virus (HSV) transmitted & s/sx

transmission: direct contact with infected oral or genital secretions

s/sx: blister(s) on or around the mouth, genitals or rectum

Herpes Simplex Virus (HSV) newborn complications

-skin, eye or mouth lesions

-encephalitis, dysfunctions of the liver/lungs/ CNS & brain

Nutritional requirements

-promotes optimal wt gain, decreases complications

-avoid empty calories, increases of 300 cal/day during last 6 months of pregnancy

Folate (folic acid)

-prevents neutral tube defects in fetus

*kale, beans

Calcium and Vitamin

-needed by mother for healthy bones & teeth

-needed by fetus for developing heart, nerves, muscle and blood clotting abilities

*sunlight, diary, tofu, almonds

Protein

-important for fetal growth

*lean meats, eggs, chicken, peanut butter

Iron

-needs for increased in pregnancy → hemoglobin production

*dried fruit, red meats, beans, fortified cereals

Weight gain

obesity: increases the risk of/f preeclampsia

wt gain is d/t: uterus, amniotic fluid, placenta

Pica common types - (eating disorder with intense craving of non-nutritive substances)

Geophagy: soil, clay or similar substances

Amylophagy: raw starch or similar substances

Pagophagy: ice or freezer frost

Care of lesbian patients

-provide respectful care to pt & partner

-ask couple what terms they prefer & advocate for inclusive forms

*challenges - discrimnation, possible denial of care, fear or disclosing orientation

Care of the expected women age >35 - risk & complications

-may take longer to conceive, chromosomal abnormalities

-GDM, placenta previa, HTN

-labor complications → C section

Childbirth preparation → Lamaze

-techniques to assist in coping with pain of labor

-centers breathing patters with focal point & relaxation

*still uses meds as an option

Childbirth preparation → The Bradley method

-deliver w/o meds or unnecessary medical interventions

-focus is on muscle control

test to determine fetal well being

look at notes