Signs and Symptoms of Ovulation

1
THE PREGNANCY EXPERIENCE
2
Situation

• Mr. and Mrs. Andrews visit the clinic and tell
  the nurse that Mrs. A has missed two menstrual
  periods, has urinary frequency, and is tired all
  of the time.

3
First Prenatal Visit

• What is the most important thing that the nurse
  can do at this first prenatal visit?

4
FIRST PRENATAL VISIT

• Most important intervention for the nurse is to
• MAKE THE PATIENT WELCOME !
• Why?
• (so the couple will continue with prenatal care)

5

• Now that the couple has been welcomed to the
  clinic, one of the first things that must be done
  is to confirm that Mrs. A is pregnant.

6

• Mrs. A says that she used a home pregnancy test
  and the results were positive.
• What are some of the advantages and disadvantages
  of using home pregnancy testing?

7
Confirm the Pregnancy
All tests rely on detection of HCG
Pregnancy Tests
Urine Hema- agglutination
Inhibition Tests
Enzyme Immunoassay Tests
Radioimmune assay Tests
8

• It is confirmed that Mrs. Andrews is pregnant.
• The nurse will continue with the assessment of
  physiological and psychological needs of the
  family.
• Assessment begins at the initial visit and
  continues throughout pregnancy.

9
Calculation of Gravida and Parity

• Obstetrical Status
• Gravida number of times pregnant regardless of
  duration or outcome
• Parity number of deliveries after the age of
  viability (20 weeks).
• It is not the number of babies that come out,
  but the number of deliveries of a pregnancy

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Calculation of Gravida and Parity

• Further Breakdown into TPAL
• T Term
• P Preterm
• A Abortions
• L Live births

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Check Yourself !

• The nurse obtained the following data from Mrs.
  Andrews. She has five year old twins that
  delivered at 35 weeks, a three year old son that
  delivered at 39 weeks, had a miscarriage last
  year at 12 weeks gestation.
• What is her gravida and parity?
• What is her gravida and parity using the TPAL
  system?

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Health History Assessment

• Collect information about
• Obstetric History -- Current and past pregnancies
• Menstrual History
• Family history--genetic and environmental factors
  that affect health
• Medical history-- diabetes, heart
• Perform Physical Examination including a Pelvic
  Examination (Pap test, measurements, cervical
  culture)
• Perform Laboratory Studies
• Hgb., Hct, Type, Rh, CBC, Rubella, Hepatitis,
  HIV

13

• Mr. and Mrs. Andrews are both excited about the
  pregnancy. It is her first so she is considered
  a Gravida 1, Para 0.
• They ask the nurse When is the baby due?
• How will you calculate this?

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Calculation of E. D. C.

• Nageles Rule
• First day of last Menstrual
• Go back 3 months
• Add 7 days
• Mrs. Andrews tells you her last menstrual period
  began on July 18.
• Her baby is due on ____________.

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TEST YOURSELF
Mrs. B. began her menses on January 21. What is
her E.D.C. using Nageles Rule?
Mrs. C. started her menses on June 27. What is
her E.D.C. using Nageles Rule?
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Problem Solving

• If Mrs. Andrews did not know the first day of her
  last menstrual period, what method of calculation
  would you use?

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• McDonalds Rule
• Use Fundal height measurement, measure from the
  symphysis to the top of the fundus.
• Months measure cm. X 2/7
• Weeks measure cm. X 8/7
• Mrs. Andrews fundal height is 7 cm. How far
  along is she?

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Assessment of Pelvic Adequacy

• Clinical Pelvimetry via ultrasound can be
  performed to determine if the pelvis is of
  adequate size to allow for a normal vaginal
  delivery.
• Manual measurement via examiner

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Assessment

• The nurse continues with assessment of Mrs.
  Andrews and gathers data regarding presumptive,
  probable, and positive signs of pregnancy.

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Presumptive Signs of Pregnancy

• Cessation of Menstruation
• Breast changes -- tenderness
• Nausea and Vomiting
• Frequent Urination
• Quickening
• Chadwicks sign
• Increased pigmentation of the Skin
• Fatigue

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Probable Signs of Pregnancy

• Enlargement of the Abdomen
• Hegars Sign -- softening of the isthus of the
  uterus
• Goodells Sign --softening of the cervix
• Braxton-Hicks contractions
• Ballotment
• Outline of the fetus by abdominal palpation
• Positive Pregnancy Test

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Positive Signs of Pregnancy

• Ausculation of fetal heart tones
• Active fetal movement felt by Trained person
• Ultrasound showing fetal outline

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Conclusion of Visit

• You are completed with Mr. and Mrs. Andrews first
  prenatal visit.
• Before they leave, it is important to discuss the
  following topics

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Conclusion of Visit

• Patient Teaching
• Diet Counseling
• Referrals
• Danger Signals
• Date of next visit

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Danger Signals

• Vaginal Bleeding
• Fluid from the Vagina
• Abdominal Pain
• Increased Temperature
• Dizziness, Blurred vision or Double Vision
• Persistent Vomiting
• Edema
• Headache
• Dysuria
• Absence of Movement of the Baby

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Needs of the Pregnant Woman and Family

• Chapter 11

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Cultural Beliefs and Practices
In working with clients of other cultures, health
professionals should be open to and respectful of
other beliefs
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Self Care during Pregnancy
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Self Care

• Employment
• Criteria for work
• is work environment safe for the fetus
• can woman carry out work commitments without
  undue stress\
• What other teaching is necessary regarding work
  and breaks.

30
Self Care

• Mrs. Andrews says that she is employed as a bank
  teller on a full time basis.
• She asks whether she can continue to work
  throughout her pregnancy

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Self Care

• Exercise, Leisure
• May attend regular prenatal exercise classes
• Dont take up a new sport
• Travel--wear seat belt

32
Safety with Seat Belts
Wear shoulder belt over top of abdomen
Wear lap belt low over the hips
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Self Care

• Safety
• Clothing
• Bathing
• Immunizations - avoid live vaccines

34
Substance Abuse

• Caution women against the use of abusive
  substances  
• Tobacco
•  Alcohol
•  Caffeine
•  Marijuana
•  Cocaine
• May need referral for further evaluation
• These can all be teratogenic and lead to
• various fetal complications
• See pages 260-262

35
Sexual Changes

• First Trimester
• Decrease in desire
• Second Trimester
• Increase in desire
•  
• Third Trimester
• Alterations needed by the couple
• Intercourse contraindicated if woman has history
  of preterm labor or ruptured membranes

36
Maternal Nutrition
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Nutrition in Pregnancy

• Increase in calories
• Increase in protein
• May have food cravings or Pica
• Nursing care
• Teach to take prenatal vitamins and iron
• Teach about normal weight gain 25 lbs.