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Signs and Symptoms of Ovulation

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What is the most important thing that the nurse can do at this ... Chadwicks sign. Increased pigmentation of the Skin. Fatigue. Probable Signs of Pregnancy ... – PowerPoint PPT presentation

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Title: 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

10
Calculation of Gravida and Parity
  • Further Breakdown into TPAL
  • T Term
  • P Preterm
  • A Abortions
  • L Live births

11
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?

12
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?

14
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 ____________.

15
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?
16
Problem Solving
  • If Mrs. Andrews did not know the first day of her
    last menstrual period, what method of calculation
    would you use?

17
  • 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?

18
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

19
Assessment
  • The nurse continues with assessment of Mrs.
    Andrews and gathers data regarding presumptive,
    probable, and positive signs of pregnancy.

20
Presumptive Signs of Pregnancy
  • Cessation of Menstruation
  • Breast changes -- tenderness
  • Nausea and Vomiting
  • Frequent Urination
  • Quickening
  • Chadwicks sign
  • Increased pigmentation of the Skin
  • Fatigue

21
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

22
Positive Signs of Pregnancy
  • Ausculation of fetal heart tones
  • Active fetal movement felt by Trained person
  • Ultrasound showing fetal outline

23
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

24
Conclusion of Visit
  • Patient Teaching
  • Diet Counseling
  • Referrals
  • Danger Signals
  • Date of next visit

25
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

26
Needs of the Pregnant Woman and Family
  • Chapter 11

27
Cultural Beliefs and Practices
In working with clients of other cultures, health
professionals should be open to and respectful of
other beliefs
28
Self Care during Pregnancy
29
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

31
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
33
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
37
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.
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