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EDC Computation - none
BS Nursing (BSNG 22A)
The Philippine Women's University
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NURSING CARE DURING PRENATAL PERIOD
I. ASSESSMENT
**A. Nursing Health History
- Estimation of EDC, AOG, LMP, FH,** Naegele’s Rule, Weight
Determining the Last Menstual Period (LMP) First day of last menstruation
Example: Last menstruation= June 14-18, 2008
LMP: June 14, 2008
Determining the Expected date of delivery (EDC) A. Naegele’s Rule
For LMP between April to December: - 3 (months) +7 (days) +1 (Year)
For LMP betwen January to March: + 9 (months) +7 (days)
Examples:
- LMP : January 15, 2005
01 15 2005
- 9 +
10 22 2005 (October 22, 2005)
- LMP : December 16 2004
12 16 2004 -03 +7 +
09 23 2005 (September 23, 2005)
Determining the Age of Gestation (AOG) Number of days since LMP to the present day divided by 7
Example: A pregnant woman comes to the clinic for an initial prenatal check up. Her LMP was December 16, 2004. Present day is February 14, 2005.
December - 15 (31 days – 16 days) January - 31 February - 14
60 days / 7 = 8 weeks and 4 days (AOG)
Mc Donald’s Rule - Formula: AOG (months)= Fundic height (in cm)÷ 4
E. FH of 24 cm = 24 ÷ 4 = 6 months (24 weeks)
***For 20 weeks AOG and above: FUNDIC HEIGHT (CM) = AOG (WEEKS)
**For below 20 weeks AOG: = FH (CM) x 8 / 7 = AOG in weeks
Bartholomew’s Rule – estimates AOG by the relative position of the uterus in the abdominal cavity
2. OB Classification: Gravida; Para;
Full term; Abortion
Obstetrical Scoring (GP TPALM)
Gravida - number of pregnancy (including present pregnancy) Parity - number of viable pregnancies who are previously born/ number of viable deliveries Term - number of children born between 37- 42 weeks AOG Preterm - number of children born before the 37th week of gestation Abortion - pregnancy that did not reach the age of viability (> 20 weeks AOG or < 400g) Living - number of CURRENTLY living children Multiple Pregnancies - (i. twins, triplets are counted as one)
**B. Physical Assessment
- Leopold’s Maneuver** Purpose: to estimate fetal size, locate fetal parts and determine presentation, position, engagement and attitude LM1: fetal presentation LM2: fetal position LM3: fetal engagement LM4: fetal attitude
AOG Anatomical Landmark: 12 weeks Slightly above the symphysis pubis 20 weeks Level of the umbilicus 36 weeks Below the xiphoid process 32 and 40 weeks Same level due to lightening on the 40th week
Position: dorsal recumbent position
Preparation: 1. The client must empty her bladder 30 minutes before examination; 2. Place a small pillow underneath the client’s hips.
2. Vital signs (BP)/ Weight 3. Fetal assessment: FHR; Fetal Movement Normal Fetal Heart Tone: 120-160 BPM Number of Fetal movement every 10 minutes: 2 for every 10 minutes Number of Fetal movement every hour: 10-12 per hour
*DIAGNOSIS OF PREGNANCY
STAGE PRESUMPTIVE PROBABLE POSITIVE
First Trimester
Amenorrhea Morning sickness Breast changes Fatigue Urinary frequency Enlarging uterus
Chadwick’s signs Goodell’s sign Hegar’s sign Positive HCG (pregnancy test) Elevation of BBT
Ultrasound evidence
Second trimester
Quickening Increased skin pigmentation; (chloasma and linea nigra) Striae gravidarum
Enlarged abdomen Braxton Hicks Contraction Ballotement
Fetal heart tone Fetal movement felt by the examiner Fetal outline on X-ray
C. Laboratory tests Urine Heat acetic- ALBUMINURIA Benedict’s tests- GLYCOSURIA Urinalysis- UTI
Blood CBC (Hgb, Hct)- ANEMIA Blood typing VDRL- SYPHILIS
4. Diagnostic Tests
Ultrasound
Intermittent ultrasonic waves are transmitted by an alternating current to a transducer, which is applied to the women’s abdomen
Two types: A. Transabdominal B. Transvaginal
Nursing Responsibilities:
Drink 1- 1 quart of water 2 hours before the procedure
Instruct the client not to void
- Rationale: Fills the urinary bladder and moves it upward and away from the uterus; when the bladder is full, the examiner can assess other structures, especially the vagina, cervix, in relation to the bladder
- Position: Supine
- If the client complains of dizziness or shortness of breath: A. Place the patient on side lying position with towel under hip B. Elevate the patient’s upper body during the test to PREVENT COMPRESSION OF VENA CAVA
Amniocentesis
It is a procedure used to obtain amniotic fluid for testing
The physician scans the uterus using ultrasound to identify the fetal and placental positions to identify adequate amount of amniotic fluids.
The skin is cleaned with betadine; local anesthesia at the needle insertion is optional; gauge 22 needle is then inserted into the uterine cavity and amniotic fluid is withdrawn.
Obtain 15-20 cc of amniotic fluid for examination
Should not be done until at least 16 weeks of gestation
A. Diagnostic Uses: Provides information on 1. Fetal Health - Assesses appropriate levels of: a. Alpha- fetoprotein (AFP) b. Human chorionic gonadotropin (HCG) c. Unconjugated estriol (UE) - Necessary for detection of DOWN SYNDROME (TRISOMY 21), TRISOMY 18, and NEURAL TUBE DEFECT
- Fetal lung maturity
- Assesses for: a. Lecithin/ Sphingomyelin (L/S) ratio-surfactant
**By 35 weeks AOG, the normal L/S ratio= 2:1; decrease risk of
- amniotic fluid volume (visualized as pockets of fluids around the fetus)
- reactive FHR with activity (reactive NST)
The first 4 variables are assessed by UTZ scanning. FHR reactivity is assessed with the NST. Determines the compromised fetus or confirms the healthy fetus
(Criteria for BPP Scoring)
A score of 2 is assigned to each normal finding and 0 to each abnormal one, for a maximum score of 10. Score of 8 (with normal amniotic fluid) and 10 are considered normal. Indication of BPP: (at risk of placental insufficiency or fetal compromise because of the following: 4. Intrauterine growth restriction (IUGR) 5. Maternal DM 6. Maternal heart disease 7. Maternal chronic HPN/ Preeclampsia/ eclampsia 8. Maternal sickle cell anemia 9. Suspected fetal post maturity 10. History of previous still births 11. Rh sensitization 12. Abnormal estriol excretion 13. Hypeethyroidism 14. Renal disease 15. Nonreactive NST
Chorionic Villi Sampling Involves obtaining a small sample of chorionic villi from the developing placenta
For 1st trimester diagnosis of genetic, metabolic, and DNA studies
Can be performed either transabdominally or transcervically
Performed between 10 and 12 weeks; thus it can not detect neural tube defect
Risk of CVS include: 6. Failure to obtain tissue 7. Rupture of membranes 8. Leakage of amniotic fluid 9. Bleeding 10. Intrauterine infection 11. Maternal tissue contamination of the specimen 12. Rh alloimmunization 13. Spontaneous abortion
II. Diagnosis Wellness diagnosis Knowledge Deficit Altered Health Maintenance Nutrition, less than required
III. Planning/ Implementation/ Evaluation
A. Nutrition – most important aspect *Nutritional assessment is based on taking a diet history first:
- food preferences/ eating habits
- cultural/religious influences
- occupation/educational level
B. Prenatal Exercises
Tailor sitting -stretches and strengthen perineal muscles; increase circulation in the perineum; make pelvic joints more pliable
Pelvic rock -maintains good posture; relieves abdominal pressure and low backache; strengthens abdominal muscles following delivery
Component Normal (score= 2) Abnormal (score= 0)
Fetal breathing
movement
≥ 1 episode of rhythmic breathing lasting ≥ 30 seconds within 30 minutes
≤ 30 seconds of breathing in 30 minutes
Fetal
movements of
body or limbs
≥ 3 discrete body or limb movements in 30 minutes (episodes of active continuous movement considered as single movement)
≤ 2 movements in 30 minutes
Fetal tone ≥ 1 episode of
extension of a fetal extremity with return to flexion, or opening or closing of hand
No movements or extension/flexion
Amniotic fluid
volume
≥ 2 accelerations of ≥ 15 beats/min for ≥ 15 seconds in 20 minutes
0-1 acceleration in 20 minutes
Non stress Test Single vertical pocket
> 2 cm
Largest single vertical pocket ≤ 2 cm
Squatting -stretches the pelvic floor muscle; should be done15 minutes daily
Pelvic Floor Contraction (Kegel’s) -promotes perineal healing; relieves congestion and discomfort in pelvic region; tones up pelvic floor muscles `
Abdominal Contractions -strengthens abdominal muscle during pregnancy and prevents constipation in the postpartal period
Walking is the best exercise during pregnancy
Jogging is questionable because of the strain of extra weight of pregnancy placed on the knees
C. Hygiene If membranes rupture or vaginal bleeding is present or during the last month of pregnancy, tub baths are contraindicated.
D. Travel Advise a woman who is taking a long trip by automobile to plan for frequent rest or stretch period
At least every 2 hours, she should get out of the car and walk a short distance
Use of seat belt is advised (shoulder harness and lap belts)
Infant car seat should be purchased
Traveling by plane is not contraindicated as long as plane is pressurized. If more than 7 months, traveling by plane is not recommended.
F. Immunization –Tetanus Toxoid
G. Nutritional Supplement 1. Folic acid 2. Iron
H. Managing Discomforts of Pregnancy
G. Clothing Use of abdominal support such as light maternity girdle for support not to compress and constrict the abdomen
Avoid knee high stockings
H. Sexual Activity Contraindicated:
- Women with history of abortion
- Rupture membrane
- Vaginal spotting
I. Prenatal visit Start of pregnancy – 32 weeks Every month
On 32-36 weeks AOG Every 2 weeks/twice a month
On 36 weeks AOG Every week until labor pains set in
EDC Computation - none
Course: BS Nursing (BSNG 22A)
University: The Philippine Women's University
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