Prenatal Care Nursing Study Guide

Learning Objectives for Prenatal Care

  • Relate and comprehend the information typically collected during the initial prenatal visit.
  • Identify and select appropriate assessments completed during follow-up (ongoing) prenatal visits.
  • Outline nursing management strategies aimed at promoting maternal self-care and minimizing common discomforts associated with pregnancy.
  • Identify and distinguish potential danger signs during different stages of pregnancy.
  • Acknowledge the significance of prenatal care as stated by Liya Kebede: "Prenatal care is one of the most effective ways to reduce maternal mortality because it identifies complications or high risks before emergency situations."

Comprehensive Client History Assessment

Nursing assessments in prenatal care must include obtaining detailed client information in the following specific areas:

  • Reproductive and Obstetrical History: Detailed accounts of previous pregnancies and reproductive health.
  • Medical History: Past and current medical conditions that may affect pregnancy.
  • Nutritional History: Evaluation of dietary habits and nutritional status.
  • Family History: Genetic conditions or health patterns within the family.
  • Recent or Current Illnesses: Identification of any acute conditions.
  • Current Medications: Listing all prescribed and over-the-counter drugs currently being taken.
  • Psychosocial History: Assessment of emotional wellbeing and social support systems.
  • Environmental Exposures: Identification of potential hazards in the home or workplace.
  • Exercise and Lifestyle: Typical physical activity levels and daily routines.
  • Abuse History: Screening for past or present physical, emotional, or sexual abuse.

Prenatal Visit Schedule for Low-Risk Clients

The following schedule is intended for clients classified as low risk with no comorbidities:

  • First Prenatal Visit: Occurs before 12 weeks12\,\text{weeks} gestation.
  • Weeks 16−2816-28: Visits are scheduled once a month.
  • Weeks 29−3629-36: Visits are scheduled every 2 weeks2\,\text{weeks}.
  • Weeks 3636 to Birth: Visits are scheduled once a week.

Components of the Initial Prenatal Visit

  • Determine Estimated Date of Delivery (EDD): Calculation of the expected due date.
  • History Collection: Obtaining a complete medical, obstetrical, and lifestyle history.
  • Physical Examination:     * Establishment of baseline weight.     * Measurement of vital signs.     * Performance of a pelvic exam.
  • Initial Laboratory Tests: Collection of baseline diagnostic data.

Diagnostic and Laboratory Testing

Initial Laboratory Tests
  • Complete Blood Count (CBC) with differential.
  • Blood type and Rh status.
  • Rubella Titer (to check for immunity).
  • Urinalysis.
  • Renal Function Test.
  • Pap Test.
  • Cervical Cultures (to screen for infections).
  • HIV Antibody testing.
  • Hepatitis B Surface Antigen.
  • Toxoplasmosis screening.
  • RPR (Rapid Plasma Reagin) for Syphilis screening.
Routine and Specialized Follow-Up Tests
  • Group B Streptococcus (GBS): Screened at 35−37 weeks35-37\,\text{weeks} gestation.
  • One-hour Glucose Tolerance Test:     * Performed at the initial visit if the client is high risk.     * An standard screening performed at 24−28 weeks24-28\,\text{weeks} for all others.
  • Three-hour Glucose Tolerance Test: Performed only if the one-hour glucose result is above 140 mg/dL140\,\text{mg/dL}.
  • PPD Screening: Used to identify exposure to Tuberculosis (TB).
  • TORCH Screening: Screens for a group of infections including Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, and Herpes Virus.
  • Maternal Serum Alpha-Fetoprotein (MSAFP):     * Screening conducted at 15−22 weeks15-22\,\text{weeks}.     * Low levels may indicate Down syndrome.     * High levels may indicate neural tube defects.

Ongoing Prenatal Assessments and Nursing Care

  • Maternal Monitoring:     * Consistent monitoring of weight and Blood Pressure (BP).     * Urine testing for glucose, protein, and leukocytes.     * Assessment for edema (swelling).
  • Fetal Monitoring:     * Fetal Heart Rate (FHR) monitored by Ultrasound (U/S) in early pregnancy.     * FHR via Dopper in the late first trimester; the clinician should listen midline, right above the symphysis pubis.     * Measurement of Fundal Height starting in the second trimester.
  • Gynecological/Physical Procedures:     * Assisting the provider with gynecological exams to check reproductive organs and the birth canal.     * Pelvic measurements to determine the adequacy of the birth canal for delivery.     * Administration of RhO(D) immune globulin (IM) at 28 weeks28\,\text{weeks} for clients who are Rh-negative and sensitized.

Leopold's Maneuvers

Nursing care includes performing or assisting with Leopold's maneuvers to palpate the presentation and position of the fetus. The process begins by observing the abdomen from the foot of the bed; the fuller side of the abdomen is often the side with the fetal legs.

  1. Fundus (Step 1): While facing the client's head, palpate the upper abdomen (fundus) to determine if the part felt is the fetal head or the buttocks.
  2. Sides (Step 2): While facing the client's head, palpate the sides of the abdomen to determine which side the arms and legs are located.
  3. Presenting Part (Step 3): While facing the client's head, determine the presenting part at the pelvic inlet (breech vs. cephalic).
  4. Pubic Symphysis (Step 4): While facing the client's feet, assess the fetal descent into the pelvis near the pubic symphysis.

Health Promotion and Client Education

Substances and Environments to Avoid
  • Over-the-counter (OTC) medications, supplements, and prescription medications (unless specifically approved by the provider).
  • Alcohol, tobacco, and any substance use during pregnancy or lactation.
  • Use of hot tubs or saunas.
Recommended Health Practices (DOs)
  • Exercise: Daily physical activity for 30 minutes30\,\text{minutes} each day.
  • Hydration: Drink at least 8−10 glasses8-10\,\text{glasses} of water daily, totaling approximately 2.3 L2.3\,L.
  • Immunizations: Receive the influenza vaccine and Tdap vaccine DURING pregnancy.

Common Discomforts of Pregnancy

  • Nausea and Vomiting.
  • Breast Tenderness.
  • Urinary Frequency and Urinary Tract Infections (UTIs).
  • Fatigue.
  • Heartburn and Constipation.
  • Hemorrhoids.
  • Backaches.
  • Shortness of Breath (SOB).
  • Leg Cramps.
  • Varicose Veins and Lower Edema.
  • Gingivitis, Nasal stuffiness, and Epistaxis (nosebleeds).
  • Braxton Hicks Contractions.
  • Supine Hypotension.

Potential Danger Signs During Pregnancy

First Trimester Danger Signs
  • Burning with Urination (Dysuria).
  • Severe Vomiting.
  • Diarrhea.
  • Fever or Chills.
  • Abdominal cramping.
  • Vaginal Bleeding.
Second and Third Trimester Danger Signs
  • Gush of vaginal fluid (Premature Rupture of Membranes).
  • Vaginal Bleeding.
  • Abdominal pain.
  • Changes in fetal activity level.
  • Persistent Vomiting.
  • Severe Headaches.
  • Fever.
  • Dysuria.
  • Blurred Vision.
  • Edema of the face and hands.
  • Epigastric pain.
  • Signs of Hyperglycemia (occurring concurrently): Flushed dry skin, fruity breath, rapid breathing, increased thirst, increased urination, and headache.
  • Signs of Hypoglycemia (occurring concurrently): Clammy pale skin, weakness, tremors, irritability, and lightheadedness.