Nursing Care Related to Assessment of a Pregnant Family
Reasons for Prenatal Health Assessment
- Establishing a baseline of present health
- Determining gestational age of fetus
- Monitoring fetal development and maternal well-being
- Identifying patients at risk for complications
- Minimizing risks by anticipating and preventing complications
- Providing education on pregnancy, lactation, and newborn care
- Para: Number of pregnancies reaching viability, regardless of outcome.
- Gravida: A person who is or has been pregnant.
- Primigravida: A person pregnant for the first time.
- Primipara: A person who has given birth to one child past age of viability.
- Multigravida: A person who has been pregnant multiple times.
- Grand multipara: A person who has given birth five or more times.
- Multipara: A person who has given birth to two or more children.
- Nulligravida: A person who has never been pregnant and is not currently pregnant.
Preconceptual Visit
- Importance of accurate reproductive life planning.
- Assurance of fertility based on health history and examination.
- Identification of any health issues needing correction.
- Determining hemoglobin level and blood type.
- Conducting Pap smear for cervical health.
Selecting a Healthcare Provider
- Importance of initiating prenatal care early.
- Role of nurses: educate, listen, and counsel patients.
Typical Day and Social History for a Pregnant Patient
- Nutrition: Assess dietary habits and needs.
- Exercise: Determine safe exercise routines.
- Hobbies: Understand personal interests that may impact health.
- Substance Use: Assess tobacco, alcohol, and drug consumption.
- Medication: Inquire about herbal and prescribed medications.
- Intimate Partner Violence: Screen for signs and provide resources if necessary.
Typical Assessments for a First Pregnancy Visit
- Health History: Demographic data, chief concern, family profile, past medical and gynecologic history, review of systems.
- Physical Examination: Baseline data including vital signs, fundal height, fetal heart sounds.
- Laboratory Assessment: Blood tests, urinalysis, and ultrasound for fetal health.
Continuing Prenatal Visits - Assessments and Interventions
- Health Interview: Assess changes since last visit, review uterine signs of danger, and address new concerns.
- Physical Examination: Regular checks of blood pressure, urine tests for glucose and protein, fetal heart rate monitoring.
- Fetal Health: Periodic fetal heart rate assessment and fundal height measurement.
- Increase the proportion of pregnant individuals receiving early and adequate prenatal care from 76.4% to 80.5%.
- Improve the proportion of women with optimal red blood cell folate levels from 82.6% to 86.2%.
- Increase individuals achieving recommended weight prior to pregnancy from 42.1% to 47.1%.
Suggestions to Individualize Prenatal Care
- Schedule appointments based on the patient's needs and convenience.
- Offer educational materials while patients wait.
- Ensure privacy during assessments and remain respectful during examinations.
- Encourage family members to participate in sessions where appropriate.
- Provide specific contact information for follow-up questions.
Assessing Health Status During Pregnancy
- Baseline Measurements: Height, weight, vital signs, mental status.
- Body System Assessment: Evaluate general health, including head, eyes, ears, nose, throat, respiratory and cardiovascular systems, and extremities.
- Pelvic Assessments: Include external and internal examinations, and cervical assessments.
- Laboratory Tests: Include CBC, STIs screening, blood typing and antibody testing, and ultrasound for fetal health assessment.
- Health-seeking behaviors regarding nutrition and pregnancy activity guidelines.
- Knowledge deficits regarding teratogen exposure.
- Cultural impacts on health-seeking behaviors.
- Risks associated with lifestyle choices affecting fetus.
Implementing Care During Pregnancy: Danger Signs to Report
- Vaginal bleeding, persistent vomiting, fever, escape of fluid from vagina, abdominal/chest pain, swelling of face and fingers.
- Changes in vision, prolonged headaches, cramping, decreased fetal movement, contractions before 37 weeks.
Risk Factors for Complications During Pregnancy
- Obstetric History: Previous miscarriages, preterm labor, complications in past pregnancies.
- Medical History: Chronic illnesses, previous surgeries, STIs, and mental health conditions.
- Lifestyle Factors: Substance abuse, inadequate prenatal care, socioeconomic factors affecting nutrition and support.
- Maternal Age: Risks associated with being under 16 or over 40 years of age.
Example Questions for Practice
- A patient’s diagonal conjugate measurement of 10.5 cm indicates a pelvis that is:
- Answer: Narrow anterior-posterior (Normal is 12.5 cm).
- Best technique for relaxing during a pelvic examination:
- Answer: "Count backward from 20 at a steady pace."