Chapter 13



Chapter 15

Antepartal Nursing Assessment

Resource Library

Prentice Hall Nursing Medialink DVD-ROM

Audio Glossary

NCLEX Review

Videos: Through the Eyes of a Nurse—The First Trimester; Through the Eyes of a Nurse—The Second Trimester; Through the Eyes of a Nurse—The Third Trimester

Companion Website

Additional NCLEX Review

Case Study: Initial Prenatal Assessment

Care Plan Activity: Initial Assessment of Primigravida

Application: Ovulation Calculator

Critical Thinking

Learning Objective 1

Summarize the essential components of a prenatal history.

Concepts for Lecture

1. Prenatal History

• Assessment of current and past pregnancies

• Gynecologic history

• Current and past medical history

• Family medical history

• Religious, cultural, and occupational history

• Partner history

Learning Objective 2

Define common obstetric terminology found in the history of maternity clients.

Concepts for Lecture

1. The following terms are used to document the obstetric history:

• Antepartum. The time between conception and labor

• Intrapartum. The time from labor until the birth of the infant and placenta

• Postpartum. The time from birth until the return to the prepregnant condition

2. Gestational terms include:

• Gestation. The number of weeks since the first day of the last menstrual period (LMP)

• Abortion. A birth that occurs before 20 weeks’ gestation or the birth of a newborn less than 500 g

• Term. Normal duration of pregnancy from 38 to 42 weeks

3. Labor and delivery terms include:

• Preterm or premature labor. The occurrence of labor after 20 weeks’ but before 37 weeks’ gestation

• Postterm labor. The occurrence of labor after 42weeks’ gestation

• Stillbirth. A fetus who is born dead after 20 weeks’ gestation

4. Pregnancy terms include:

• Gravida. Pregnancy, regardless of duration

• Nulligravida. Never been pregnant

• Primigravida. A first pregnancy

• Multigravida. A second or subsequent pregnancy

5. Birth terms include:

• Para. The birth after 20 weeks’ gestation

• Nullipara. Never given birth at more than 20weeks’ gestation

• Primipara. One birth at more than 20 weeks’ gestation

• Multipara. Two or more births at more than 20weeks’ gestation

6. The terms “gravida” and “para” describe pregnancies, not number of fetuses.

T: number of term infants born

P: number of preterm infants born

A: number of pregnancies ending in either spontaneous or therapeutic abortion

L: number of currently living children.

Learning Objective 3

Identify factors related to the father’s health that should be recorded on the prenatal record.

Concepts for Lecture

1. Information about the father’s health that should be recorded in the prenatal record include the presence of genetic conditions or diseases in him or in his family history, his age, significant health problems, previous or present alcohol intake, drug use or tobacco use, his blood type and Rh factor, occupation, educational level, methods by which he learns best, and his attitude toward the pregnancy.

Learning Objective 4

Describe the normal physiologic changes one would expect to find when performing a physical assessment on a pregnant woman.

Concepts for Lecture

1. Normal Changes in Pregnancy

• Skin

° Spider nevi common

° Pigmentaton changes—linea nigra, striae gravidarum, melasma

• Nose

° May be edematous

• Mouth

° May have hypertrophy of gingival tissue

• Thyroid

° Slight hyperplasia by third month

• Breasts

° Size increase noted in first 20 weeks

° Become nodular

° Tingling sensation in first and third trimesters

° Pigmentation of nipples and areolae darken

° Superficial veins dilate and become more prominent

° Striae in multiparas

° Tubercles of Montgomery enlarge

° Colostrum may be present after 12 weeks

• Heart

° Palpitations may occur

° Short systolic murmurs

• Abdomen

° Purple or silver striae may be present

° Linea nigra

° Diastasis of the rectus muscle

° Progressive enlargement

° Ballottement

• Spine

° Lumbar spinal curve may be accentuated

• Pelvis

° Enlargement in anteroposterior diameter

° Softening of cervix (Goodell’s sign), softening of isthmus of uterus (Hegar’s sign), cervix takes on bluish coloring (Chadwick’s sign)

° Uterus is pear shaped, mobile, and smooth

Learning Objective 5

Explain the use of Nägele’s rule to determine the estimated date of birth.

Concepts for Lecture

1. To estimate the date of birth (EDB), Nägele’s rule is used. To derive a date, begin with the first day of the LMP, subtract 3 months, and add 7 days.

Learning Objective 6

Develop an outline of the essential measurements that can be determined by clinical pelvimetry.

Concepts for Lecture

1. Clinical pelvimetry can provide essential measurements to assist the healthcare provider in making clinical birth decisions. Important anteroposterior diameters of the inlet for childbearing are the diagonal conjugate; the obstetric conjugate; and the conjugata vera, or true conjugate. The important midpelvic measurements include the plane of least dimension, or midplane, and transverse diameter. The important pelvic outlet measurements include the anteroposterior diameter and the transverse diameter. Estimation of the suprapubic angle and the length and shape of the pubic rami are also important. The height and inclination of the symphysis pubis and the contour of the pubic arch are important measurements as well.

Learning Objective 7

Describe areas that should be evaluated as part of the initial assessment of psychosocial factors related to a woman’s pregnancy.

Concepts for Lecture

1. Psychosocial Assessment

• History of emotional or physical abuse

• History of emotional problems

° Depression and anxiety in general

° Postpartum depression

• Support systems

2. Psychosocial Assessment

• Overuse or under use of healthcare system

• Acceptance of pregnancy, intended or unintended

• Personal preferences about the birth

• Plans for care of child following birth

• Feeding preference for the baby

Learning Objective 8

Relate the danger signs of pregnancy to their possible causes.

Concepts for Lecture

1. Danger Signs of Pregnancy

• Gush of fluid from vagina

• Vaginal bleeding

• Abdominal pain

• Fever

• Dizziness, blurred vision, spots before eyes

• Persistent vomiting

2. Danger Signs of Pregnancy

• Edema

• Muscular irritability or convulsions

• Epigastric pain

• Oliguria

• Dysuria

• Absence of fetal movement

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