Copyright 2002, Delmar, A division of Thomson Learning Chapter 23 Pregnant Patient

Copyright 2002, Delmar, A division of Thomson Learning

Chapter 23

Pregnant Patient


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.


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


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


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


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


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


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


Assessment Equipment

Stethoscope Fetoscope Urine specimen supplies Tape measure

General approach Privacy Quiet environment


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


Common Antepartum Tests Ultrasound Genetic testing Nonstress test Amniotic fluid volume Biophysical profile Fetal movement count


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


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


Learning Needs Consider social services consultation Provide appropriate educational

materials Topics

What to expect during pregnancy Self-care Follow-up health needs Infant care

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Copyright 2002, Delmar, A division of Thomson Learning Chapter 23 Pregnant Patient