PRE-NATAL CARE

JENNIFER F. AFICIAL MAN. RN.

 HEALTH ASSESSMENT DURING 1ST PRENATAL VISIT.

Women should schedule a first prenatal visit as soon as they suspect they are
pregnant
Return appointments are usually scheduled:
every month - 1-8 months of from pregnancy is detected to 32 weeks AOG
2x/month or every 2 weeks - 32-37 weeks
weekly - 37 weeks - birth or EDB
2x/week - for all post-term or >42weeks
Women categorized as HIGH RISK should have a check-up more
frequently

SCREENING INVOLVES:
Extensive health history
Complete physical exam (including pelvic exam)
Obtaining blood and urine specimen for laboratory analysis

SCREEN FOR DANGER SIGNS THAT MIGHT REVEAL A COMPLICATION IS

BEGINNING:
Hypertension
Demographic data

COMPONENTS OF HEALTH
Past & Present Medical History (Menstrual, Gynecologic,
Obstetric)
G.P., OB score, LMP
Head to toe assessment
include also heart, lungs, other extremities and skin
Nutrition

HISTORY
Folic acid (minimum 400mg/day)
CHO, CHON, FAT
Magnesium, Ca, Phosphorous
Iodine, Sodium, Zince
Exercise
Tobacco / Alcohol / Drug consumption - this is associated
with pre-term / low birth weight infants
Medications - supplements or certain medications could
be detrimental if it is not prescribed
Support system (partner violence, teenage pregnancy, rape
victim etc)
 BASELINE DATA:
Height, weight, prepregnancy BMI
VS
Fundal Height measurement (after 12weeks), fetal heart sounds
PHYSICAL EXAMINATION

SYSTEM ASSESSMENT:
full physical exam to confirm general health
Pelvic Exam
pelvic measurements

LABORATORY ASSESSMENT:
blood
CBC
blood type & RH
Maternal serum a-fetoprotein (MSAFP)
pregnancy associated plasma protein A (PAPP-A)
antibody titer against Rh, HepB, possibly C, rubella, varicella, HIV
electrolytes - sodium, potassium, creatinine
urinalysis
clean catch for glucose, protein and culture
tubercolosis
PDD; Mantoux test
ultrasound
to date pregnancy or confirm fetal health
ANTENATAL CARE
JENNIFER F. AFICIAL MAN. RN.
 DETECT:

1. PROM - 2. ANEMIA 4. DM
PREMATURE HEMOGLOBIN, ORAL
RUPTURE OF HEMATOCRIT GLUCOSE
MEMBRANE 3. PREECLAMPSIA TOLERANCE
<37 WEEKS BP TEST
PRE-TERM
LABOR
 HEART
HEAD TO TOE (INCLUDE
LUNGS
SKIN, BREAST)
OPTHALMOSCOPY FOR
VS
HYPERTENSIVE AND
THYROID
DIABETIC WOMEN
GENRAL EXAM

ABDOMINAL EXAM:

INSPECTION:
Shape, size, symmetry, fetal movement, surgical scars
Cutaneous signs of pregnancy
linea nigra, striae gravidarum / albicans, umbilicus flat / inverted,
superficial veins
PALPATION:
uterine size via symphysis pubis
fundal height
number of fetus
presentation
lie of fetus
position (anterior, posterior, transverse depending on presenting part)
attitude (full flexion / not)
Leopold's maneuver (4 grips)
AUSCULTATION:
fetal heart sound
PERCUSSION:
polyhydramnions using ballotement and fluid thrill
ACTIVE LABOR
JENNIFER F. AFICIAL MAN. RN.
1. DILATATION PHASE

ESSENTIAL

INTRAPARTUM

NEWBORN

CARE

STAGES OF LABOR
2. FETAL EXPULSION

ESSENTIAL

INTRAPARTUM

NEWBORN

CARE

STAGES OF LABOR
2. FETAL EXPULSION

ESSENTIAL

INTRAPARTUM

NEWBORN

CARE

STAGES OF LABOR
3. PLACENTAL EXPULSION

ESSENTIAL

INTRAPARTUM

NEWBORN

CARE

STAGES OF LABOR
4. IMMEDIATE POSTPARTUM /
RECOVERY PERIOD
ESSENTIAL

INTRAPARTUM

NEWBORN

CARE

STAGES OF LABOR
POSTPARTUM
JENNIFER F. AFICIAL MAN. RN.
 ASSESSMENT

B U B B L E S H E
 BREAST
Palpate both breasts for engorgement/filling. Minimize palpation for bottle- feeding
mother to avoid stimulation.
2. Check nipples for pressure sores, cracks, or fissures. Evaluate whether nipples are
everted, flat, or inverted.
3. All mothers should wear a supportive bra 24 hours a day for the first few days
postpartum.
4. Engorgement- usually occurs 2-3 days post-partum. Teach mom to:
1. apply warm packs or K-pad 15-20 minutes pre-nursing
2. try a warm shower before nursing
3. ice bags and/or binders for non-nursing moms

UTERUS
The fundus is palpated for the following:
1. Height - Record finger widths above or below the umbilicus.
2. Position - Fundus should be midline near the umbilicus
3. A full bladder may push the fundus to the R or L of the umbilicus and cause the pt’s flow to be heavier.
4. Tone - Fundus should remain firm
5. If uterus becomes boggy gently massage the uterus to help the muscles to contract
BLADDER
1. Encourage voiding q2hrs
2. Should void 8hrs after delivery
3. Output should not be less than 1.5dl/day
4. Assess for frequency, burning and urgency
5. Assess for bladder distention
6.Do Kegel's

BOWEL
1. Assess bowel sounds - hyperactive / absent
2. NSD must have bowel within 24hrs (CS 2-3 days)
3. Often sent home with stool softeners & encouraged to eat
fiber & exercise.
LOCHIA
1. RUBRA
2. SEROSA
3. ALBA
4. Document amount

EPISIOTOMY
1. Redness
2. Edema
3. Ecchymosis
4. Discharge
5. Approximation - edge of wound should be closed
SKIN
1. BLUE - decreased O2
2. YELLOW - jaundice
3. RED - inflammed / infection
4. WHITE - pallor
5. check for striae, cholasma

HOMAN'S SIGN
Homan’s Sign q shift
Assess peripheral pulses and for presence of and amount of edema
discomfort in the calf with passive dorsiflexion of the foot (+ Homan's)
indicates deep vein thrombosis
EMOTIONAL STATE
3 PHASES:
1. “Taking In”
immediately after delivery till up to 2 days postpartum
need rest and sleep
self-focus
relives events of Labor and Delivery

2. “Taking Hold”
becomes independent
usually encompasses days 2 - 5 postpartum
interested in self-care
optimal time for teaching
focus on caring for baby

3. “Letting Go”
reestablishes relationships with others with outward focus
acknowledged and accepted the real child
THANK YOU SO MUCH!