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Copyright 2002, Delmar, A division of Thomson Learning
Chapter 23
Pregnant Patient
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Competencies Describe the characteristics of the
most common pregnancy-related complaints.
Assess the psychosocial status of a pregnant woman.
Differentiate the normal changes of pregnancy from pathological changes.
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Competencies Perform a physical assessment on
a pregnant woman. Assess the learning needs of a
pregnant woman.
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Anatomy and Physiology Skin and hair
Alterations in pigmentation Skin Vascular
Head and neck Enlarged thyroid gland
Eyes, ears, nose, mouth, and throat Visual changes Nasal congestion
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Anatomy and Physiology Breasts
Early changes Late changes
Thorax and lungs Increased oxygen consumption Increased carbon dioxide excretion Diaphragmatic breathing Increased tidal volume
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Anatomy and Physiology Heart and peripheral vasculature
Increased blood volume Increased heart rate Diastolic blood pressure changes
Abdomen Displaced abdominal organs Decreased bowel sounds Increased GI emptying time
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Anatomy and Physiology Urinary system
Increased glomerular filtration rate Urinary frequency Increased risk for glycosuria,
proteinuria, nocturia
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Anatomy and Physiology Musculoskeletal system
Widening of symphysis pubis Unsteady gait Lordosis
Neurological system Common changes include headache,
numbness, tingling
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Anatomy and Physiology Female genitalia
Uterine changes Increased cervical vascularity and
friability Hematological system
Increased WBC Increased RBC volume Increased plasma volume Decreased platelets
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Anatomy and Physiology Anus and rectum
Decreased GI tone and motility Increased risk for hemorrhoids
Endocrine system Increased BMR Increased resistance to insulin
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Psychosocial Risk Factors Abuse risk factors
Frequent visits with vague complaints
Injuries are inconsistent with complaints
Fails to plan for baby’s arrival Frequently misses appointments
Abuse crosses all socioeconomic groups
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Health History Age
Greater risk for complications associated with woman < 17 or > 35
Race Increased risk for hypertension and
preterm delivery in African Americans Common chief complaints
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Past Health History Medical history
Presence of chronic disease Surgical history
Uterine, cervical, or abdominal surgeries
Medications Prescribed Over the counter Risk for teratogenic effect
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Past Health History Communicable diseases
Mumps Measles Rubella Varicella Toxoplasmosis CMV
Allergies Injuries/accidents
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Past Health History Special needs Childhood illnesses
Rheumatic heart disease Immunizations
Typically avoided during pregnancy May receive hepatitis B series during
pregnancy
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Past Health History Family history
Maternal Paternal
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Past Health History Social history
Substance use Sexual practices Travel history Work environment Home environment Hobbies/leisure activities Stress Ethnic background
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Past Health History Health maintenance activities
Sleep Diet Exercise Use of safety devices Health checkups
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Obstetric History Present
LMP History since LMP S & S of pregnancy Use of fertility drugs Due date
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Obstetric History Past
Complications Type of
delivery Length of labor Infant gender,
weight, Apgar score
Breastfeeding difficulties
Gravida, para
Abortions
Multiple births
Living children
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Assessment Equipment
Stethoscope Fetoscope Urine specimen supplies Tape measure
General approach Privacy Quiet environment
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Physical Assessment General assessment, vital signs,
weight Close monitoring of blood
pressure and weight changes Skin and hair
Pigment, skin, vascular changes
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Physical Assessment Head and neck
Thyroid function Eyes, ears, nose, mouth, and throat
Visual changes Status of oral mucosa
Breasts Shape of nipples and areola
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Physical Assessment Thorax and lungs
Breath sounds Diaphragmatic breathing
Heart and peripheral vasculature Heart sounds Presence of edema
Abdomen
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Physical Assessment Urinary system
Urinalysis Urine culture
Uterine size Fundal height
Musculoskeletal system Neurological system
Abnormal findings include seizures, eclampsia, hyperreflexia
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Physical Assessment Female genitalia
Uterine size appropriate for gestational age Uterine and cervical changes
Fetal heart rate Doppler Fetoscope Normal rate is between 110 to 160 bpm
Leopold’s maneuver Determine fetal presentation
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Physical Assessment Hematological system
Prenatal panel Endocrine system
Glucose screen Glucose is abnormal if results
are > 130 to 140 mg/dl or 120 mg/dl after meals
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Common Antepartum Tests Ultrasound Genetic testing Nonstress test Amniotic fluid volume Biophysical profile Fetal movement count
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Danger Signs of Pregnancy Vaginal bleeding Leaking or gush of watery fluid Abdominal or pelvic pain Severe headache or blurred vision
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Danger Signs of Pregnancy Persistent chills or fever > 102°F Persistent vomiting Decreased fetal movement or
lack of fetal movement Change in vaginal discharge Frequent uterine contractions
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Psychosocial Assessment Feelings about pregnancy Mood changes Adaptation to pregnancy Assess age, prior history, family
history Shift from focus on self to focus
on the fetus’s well-being
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Learning Needs Consider social services consultation Provide appropriate educational
materials Topics
What to expect during pregnancy Self-care Follow-up health needs Infant care