Signs and Symptoms of Ovulation

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THE PREGNANCY EXPERIENCE Summer
2013 Ann Hearn MSN, RNC
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Tiny Feet
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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.

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First Prenatal Visit

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

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FIRST PRENATAL VISIT

• Most important intervention for the nurse is to
• MAKE THE PATIENT WELCOME !
• Why?

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• 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.
• 
  
  

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• 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?

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Home Pregnancy Testing

• Advantages
• Easily available
• Uncomplicated
• Convenient
• Have a greater than 97 accuracy
• Minimal time

• Disadvantages
• Must be able to follow the directions as
  described or can lead to improper collection and
  errors in performing or reading the test
• False positive results
• anticonvulsants, aspirin, tranquilizers,
  marijuana
• False negative results diuretics, promethazine
• Expensive

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What other types of pregnancy tests might be
utilized to confirm the pregnancy?
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Confirm the Pregnancy
All tests rely on detection of HCG
Pregnancy Tests
Urine Hema- agglutination
Inhibition Tests
Enzyme Immunoassay Tests
Radioimmune assay Tests
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• 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.

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Legal Implication

• Nurses must exercise caution when discussing
  obstetric history with the expectant mother in
  the presence of her family or significant other.
• The confidentiality of the pregnant woman must
  always be protected.
• Why?
  

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Health History Assessment

• Collect information about
• Obstetric History -- Current and past pregnancies
• Menstrual History Is there regularity?
• 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

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Pelvic Measurement
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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 delivered,
  but the number of deliveries

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Calculation of Parity

• Further Breakdown into TPAL
• T Term
• P Preterm
• A Abortions
• L Living children

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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, and 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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• Mr. and Mrs. Andrews are both excited about the
  pregnancy. It is her fourth so she is considered
  a Gravida 4, Para 2 accoding to the prior
  scenario.
• 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

• 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
• Fatigue

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Probable Signs of Pregnancy

• Enlargement of the Abdomen
• Hegars Sign
• Goodells Sign
• Braxton-Hicks contractions
• Ballottment
• Outline of the fetus by abdominal palpation
• Positive Pregnancy Test
• Chadwicks Sign
• Increases Pigmentation
• Ausculation of Uterine and Fetal Souffle

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Positive Signs of Pregnancy

• Ausculation of fetal heart tones
• Active fetal movement felt by trained
  Practitioner
• Ultrasound showing fetal outline and fetal heart
  beat

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Conclusion of Visit

• You have completed Mr. and Mrs. Andrews first
  prenatal visit.
• it is important to discuss information that will
  help ensure a good outcome

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Conclusion of Visit

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

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Danger Signals
Return

• 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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• The End
• Return