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?
4FIRST 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?
12Health 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?
18Assessment 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
26Needs of the Pregnant Woman and Family
27Cultural Beliefs and Practices
In working with clients of other cultures, health
professionals should be open to and respectful of
other beliefs
28Self 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
32Safety with Seat Belts
Wear shoulder belt over top of abdomen
Wear lap belt low over the hips
33Self Care
- Safety
- Clothing
- Bathing
- Immunizations - avoid live vaccines
34Substance 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
35Sexual 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
36Maternal 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.