Chapter 11: Nursing Care Related To Assessment of Pregnant Family
Chapter 11: Nursing Care Related To Assessment of Pregnant Family
Chapter 11: Nursing Care Related To Assessment of Pregnant Family
Prenatal care is a major strategy for helping to reduce complications of pregnancy such as
the number of preterm or low birth weight babies born each year
Ideally, preparations for a healthy pregnancy begins during a woman's childhood
2. Components of the health history (pp.231, table 11.1: patient profile: typical day
and social history for a pregnant patient)
a) Demographic data
usually obtained including name, age, telephone number, e-mail address, religion,
ethnicity, type and place of employment, and health insurance information
b) Chief concern
The reason the woman has come to the healthcare setting
Document the date of her last menstrual period
Elicit information about the usual sign that occurs with early pregnancy such
as nausea vomiting breast changes or fatigue
As if she is feeling any discomfort with her pregnancy such as constipation
backache or frequent urination
Document whether the pregnancy was intended
c) Family Profile
It helps you get to know her, identify here important support person, shape the
nature and kind of questions you want to ask, and evaluate the possible impact of
the woman's culture on care
Marital status and support people available
Educational level of her and her partner
Know exactly what her job consists
Size and structure of the apartment of the house
Family composition
Lifestyle
Document whether a woman has recently experienced any lifestyle
changes
3. Gynecologic History
a) Menstrual History
Information to obtain includes your age of menarche and how well she was
prepared for it.
Ask about her usual cycle, including the interval, duration, amount of menstrual
flow, and any discomfort she feels
c) Past Surgery
Can influence a woman’s ability to conceive and give birth
d) Reproductive Planning
e) Sexual History
Establish a woman's risk for contracting a sexually transmitted infection such as
herps or hepatitis c
Include history taking regarding patient sexual and rotation and gender identity as
there are an increasing number of patients who go more comfortable discussing
their gender
5. Review of Systems
It completes the subjective information of health history.
Use a systematic approach such as a head-to-toe and explain what you will be
doing by an explanation.
It also helps women recalled concerns they forgot to mention earlier, such as a
urinary tract infection, a condition that can influence the outcome of the
pregnancy and thus would be important to your history taking
6. Interview Conclusions
Ask if there is anything you have not covered that the woman want to discuss
D. Physical Examination
Ask a woman to void for a clean catch urine specimen before the examination because this
will provide a urine specimen for either immediate dipstick or laboratory testing of bacterial,
protein, glucose, and ketone determination
Note: empty bladder makes the pelvic examination more comfortable.
1. Baseline Height/Weight and Vital Measurement
Measured at a first prenatal visit to establish a pregnancy BMI to serve as a bust baseline
for future comparison
When obtaining a woman's weight, be certain to convey an air of “weight gain is healthy”
so a woman feels comfortable gaining 30 to 40 pounds during pregnancy
Measure vital signs, including blood pressure, respiratory rate, and post rate, again , for
baseline level
4. Pelvic Examination
Information on the health of both a woman's internal and external reproductive organ
Equipment required is on page 242
Have the reputation of being painful and causing a loss of modesty
May be particularly difficult if a patient has a history of sexual abuse or assault
Allow a woman the opportunity to walk with the person performing the examination while
sitting up, before being placed in lithotomy position, because this enhance self-esteem and
control.
If a woman is an uncomfortable lithotomy position, the exam can be done with her lying flat on a
bed or table with her knees raised. make sure her buttocks extends slightly beyond the end of the
examining table if possible. place a pillow under her head or slightly elevate the head of the
examination table to help her relax your abdominal muscles. properly drape her with a draw sheet
over her abdomen that extends over her legs for modest.
give explanations of what is happening, what she might be feeling and what the examiner doing
The conversation is not helpful and breathes in and out technique can help her relax
a) External genitalia
Herpes simplex 2: appears as clustered, pinpoint vesicles on an
erythematous (reddened) base on vulva that feel painful when touched or
irritated.
Skene glands that empty into urethra and Bartholin glands that enter the
posterior vagina : checked for size and consistency
b) Internal Genitalia
Must be opened and held open with speculum
The cervix is inspected for position and color
Trichomoniasis: a protozoal infection that causes petechial spots on the
vaginal walls, cervical redness and a profuse, whitish, bubbly discharge
Candidal Infection: cause an itching and burning sensation in addition to
producing a clumpy cheese-like discharge that may cause bleeding.
Gonorrhea infection: thick, greenish-yellow discharge and extreme
inflammation.
Carcinoma of cervix: irregular, granular growth
Cervical polyps: red, soft, pedunculated benign protusions
c) Papanicolau Smear
Taken from the endocervix at a first prenatal visit to be certain a precancerous or
cancerous condition of the uterine cervix, vulva, or vagina is present
Bethesda system used to interpret pap smears (pp. 245, table 11.6)
d) Vaginal Inspection
Speculum Examination:
Trichomoniasis: microscope slide wet mount sample
Group B streptococcus:done at 35 to 37 weeks of gestation
f) Rectovaginal Examination
Index finger is reinserted into vagina and middle fingers into rectum. By palpating
the tissue between examining fingers in this way, it is possible to assess the
strength and irregularity of the posterior vaginal wall. It can be uncomfortable
because of rectal pressure.
For obstetric purposes, pelvis divide into false pelvis and true pelvis
1) False pelvis
Supports the uterus during late months of pregnancy
Aids in directing the fetus into the true pelvis of birth
Divided from the true pelvis only by an imaginary line, the linea terminalis
Inlet- entrance of true pelvis or upper ring bone through which the
fetus must pass to be born vaginally.
Outlet- inferior portion of the pelvis, or that portion bounded in the
back by the coccyx, on the sides by the ischial tuberosities, and in front
by the inferior aspect of the symphysis pubis
Pelvic cavity- space between the inlet and outlet.
E. Laboratory Assessment
1. Urinalysis
Urine is tested for proteinuria (protein in urine), glycosuria (glucose in urine), nitrites
(bacteria in urine), and pyuria 9white blood cells in urine)
3. Tuberculosis Screening
A small amount (0.1 ml) of tuberculin units are injected by a needle and syringe
intradermally
Can be also be done by a blood serum test called an interferon-gamma release assay
(IGRA)
4. Ultrasonography
May also be done ideally between 11 and 13 weeks of pregnancy
F. Risk Assessment (pp. 252, table 11.7: assessments that might categorize a pregnancy at
risk)