Preconception Care

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Preconception Care. Promotion of health before pregnancy Identify areas that might unfavorably affect pregnancy. Risk Factors for adverse pregnancy outcomes. Smoking Alcohol Folic Acid Obesity Drugs Medical conditions. Nursing Management. Assessment History - PowerPoint PPT Presentation

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Urinary Tract 1. Normal function

Preconception CarePromotion of health before pregnancyIdentify areas that might unfavorably affect pregnancy.Risk Factors for adverse pregnancy outcomesSmokingAlcoholFolic AcidObesityDrugsMedical conditionsNursing ManagementAssessment HistoryHealth promotion activities and educationPrenatal Care Essential for ensuring the overall health of newborns and their mothers.Ideally, begins during the mothers childhood.Includes balanced nutrition, adequate immunizations, positive attitudes and education.Choosing a health care providerclinicHMOnurse midwifeobstetricianfamily practitionerPreconceptual VisitBefore becoming pregnant to obtain accurate reproductive life planning.

First Prenatal VisitEstablish a baselineTreat any health problems

First Prenatal VisitInterviewprovide privacywhen scheduling the appointment caution the woman that it may be a long sessionestablish your roleprovide face to face interviewComponents of Health History:Establish rapportGain data on physical and psychosocial healthFirst Prenatal VisitObtain basis for anticipatory guidance for the pregnancyDemographic dataChief concernsFamily profileHistory of past illnessesHistory of family illnessesDay history/social profileGynecologic historyReview of systems

Obstetric History

TermsViability: 24 weeks: earliest age fetal survivalAbortion:Pregnancy terminated before viability (spontaneous or elective)Term: Infants born > 37 weeksPretermInfants born 24-36 weeksLivingFirst Prenatal VisitSupport Persons Role:Partners, children, best friends come to prenatal visits.Also allow time for privacy at each visit.Physical Examination:woman should undress, put on a patient gown, and empty her bladder.Obtain urine specimen (clean catch)bacteriuria, protein, glucose, ketonesVS, height, weight baselinePhysical ExaminationAssessment of systems:general appearance and mental statushead and scalpeyesnoseearssinusesmouth, teeth and throatnecklymph nodesbreastsheartlungsbackrectumextremities and skin

Measurement of Fundal Height/FHPalpate the fundus at 12 weeksmeasure the fundal heightplot on graphauscultate fetal heart with doppler at 10 to 12 weekspalpate fetal outline at 28th week

Pelvic Examination:Reveals health information on internal and external reproductive organs.Equipment - speculum, brush/broom for cervical scrapings, slide/medium for PAP, culture tube, gloves, lubricant, 2-3 cotton tipped applicators, light and stool.Support is needed during this exam

Pelvic ExaminationExternal GenitaliaCheck for signs of infection, inflammation, irritation, redness, ulceration, discharge or herpes.Check Skene and Bartholin glands for infection.Check for rectocele or cystocele.Pelvic ExaminationInternal GenitaliaCervix - purple if pregnant, check for lesions, ulcerations, or discharge.Nulligravida - a woman who is not or never has been pregnant. Cervical os is round and small.In a woman with previous pregnancy the os will be more slitlike. Pap SmearSample from cervical os or vaginal pool.Pelvic ExaminationVaginal InspectionCulture for gonorrhea, chlamydia or group B strepDark blue to purple color.Examination of Pelvic OrgansBimanual exam to assess position, contour, consistency and tenderness of pelvic organs.Palpate uterus, ovaries and check Hegars sign.Rectovaginal ExaminationAssess strength and irregularity of posterior vaginal wall.

Pelvic ExaminationTypes of pelvisAndroid - male pelvis, the pubic arch forms an acute angle, making the lower dimensions of the pelvis extremely narrow.Anthropoid - ape like pelvis, the transverse diameter is narrow and the anteroposterior diameter of the inlet is larger than normal.Gynecoid - normal female pelvis, inlet is well rounded forward and backward, the pubic arch is wide. Ideal for childbirth. Platypelloid - flattened pelvis, inlet is an oval, smoothly curved, but the anteroposterior diameter is shallow. A fetal head might not be able to rotate to match the curves of the cavity.Pelvic ExaminationDiagonal conjugate - distance between anterior surface of sacral prominence and anterior surface of inferior margin of symphysis pubis.Most useful measurement for estimation of pelvic size.Anteroposterior diameter of the pelvic inlet.Sacral prominence to symphysis pubis.Pelvimeter If measurement is more than 12.5 cm it is adequate (average is 11cm in diameter).

Pelvic ExaminationIschial tuberosity - measures is the distance between the ischial tuberosities, or the transverse diameter of the outlet.The narrowest diameter at that level.Medial and lowermost aspect of the ischial tuberosities at the level of the anus.Pelvimeter or ruler is used.11 cm is adequate because it will allow the widest part of the fetal head, or 9 cm, pass freely through the outlet.Laboratory Assessment Blood studiesCBC, H&H and red cell index (anemia), platelet count, sickle cell trait.VDRL or RPRBlood typing (include Rh factor)AFP at 16 to 18 weeksIndirect Coombs test (Rh antibodies) repeat at 28 weeks.Antibody titers for rubella and hepatitisBlood Studies Antibodies for varicellaObtain consent for HIV screening (ELISA) Western blot (Can start AZT).50-g oral 1-hour glucose loading or tolerance test to R/O diabetes if she has a previous history or symptoms of diabetes.Urinalysistest for albuminuria, glycosuria and pyuria.Laboratory Assessment Tuberculosis ScreeningPPD (purified protein derivative) tuberculin test to screen for tuberculosis.Positive requires a chest X-rayUltrasonographyConfirms pregnancy length or document healthy fetal growth.Risk AssessmentPrevious surgery, health history, meds, etcSigns Indicating Complications of PregnancyVaginal BleedingPersistent VomitingChills and FeverSudden escape of clear fluid from vaginaAbdominal or chest painPIH signsIncrease or decrease fetal movement

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