MCN QUIZ 2 REVIEWERS
Prenatal care, essential for ensuring the overall health of newborns and their mothers, is a
major strategy for helping to reduce complications of pregnancy such as the number of low-
birth-weight babies born yearly (Crombleholme, 2009). It is so important that several
National Health Goals speak directly to it (Box 11.1).
PRENATAL CARE STARTS WHEN:
>Adequate nutrition – calcium and Vit. D intake (pelvic)
>Immunization – e.g. Rubella
>Healthy lifestyle includes a positive attitude about sexuality, womanhood, and childbearing.
>Practicing safer sex, regular pelvic examinations, and prompt treatment of any sexually
transmitted infection to prevent complications that could lead to subfertility. (Katsufrakis &
Workowski, 2008).
>No vices – e.g. Smoking, recreational drugs.
>Planned pregnancy – when using reproductive life planning.
• Prenatal visit – For health promotion
• Prenatal visit - time for additional health promotion, pregnancy education, and
development of a positive pattern of healthy behaviors for the family to use in the future
(your agenda).
• Need for health promotion will depend on the ff: (Bernstein & Weinstein, 2007)
>lifestyle
>age
>parity of the mother
>degree of family support
• Lack of prenatal care is associated with the birth of preterm infants and various
complications for a woman such as hypertension of pregnancy
HEALTH PROMOTION DURING PREGNANCY
The purposes of prenatal care are to:
• Establish a baseline of present health
• Determine the gestational age of the fetus
• Monitor fetal development and maternal well-being
• Identify women at risk for complications
• Minimize the risk of possible complications by anticipating and preventing problems before
they occur
• Provide time for education about pregnancy, lactation, and newborn care
The Preconceptual Visit
• Ideally, women should schedule an appointment with a physician or nurse-midwife before
becoming pregnant. (reproductive health, fertility, detect problem)
• Hemoglobin level and blood type (including Rh factor) can be determined; a Papanicolaou
(Pap) test can be taken, and minor vaginal infections such as those arising from Candida or
chlamydia can be corrected to help ensure fertility.
1. The Initial Interview
• A woman may be asked to complete some of the forms.
• Good interviewing technique.
• GOOD RAPPORT = ASSURANCE
• A pregnant woman provides vague answers instead of specific information to questions
about these areas.
• Outside pressures like work and other children may shorten the length of interview.
An initial interview serves several purposes:
• Establishing rapport
• Gaining information about a woman’s physical and psychosocial health
• Obtaining a basis for anticipatory guidance for the pregnancy
2. Components of the Health History
a. Demographic Data - name, age, address, telephone number, e-mail address, religion, and
health insurance information.
b. Chief Concern - reason a woman has come to the health care setting—in this instance, the
fact that she is or thinks she is pregnant.
• To help confirm pregnancy, inquire about the date of her last menstrual period and whether
she has had a pregnancy test or used a home test kit.
• Check for signs/symptoms; discomforts of pregnancy; danger signs of pregnancy.
• Document if pregnancy is planned.
c. Family Profile
• get to know the client, identify important support persons, shape the nature and kind of
questions to be asked, and evaluate the possible impact of a woman’s culture on care.
• lays a foundation for health teaching.
• you need to know her age and that of her sexual partner (genetics).
• Educational level and occupation
d. History of Past Illnesses
• a past condition can become active during or immediately following pregnancy.
• kidney disease, heart disease (coarctation of the aorta and heart valve problems from
rheumatic fever cause problems most often), hypertension, sexually transmitted infections
(including hepatitis B and human immunodeficiency virus [HIV]), diabetes, thyroid disease,
recurrent seizures, gallbladder disease, urinary tract infections, varicosities, phenylketonuria,
tuberculosis, and asthma.
• Flu vaccine and vaccine against poliomyelitis with the Salk (killed virus) are the only
vaccines allowed for pregnant mothers.
e. History of Family Illnesses
• illnesses that occur frequently in the family and so can help identify potential problems.
(CV, renal, cognitive impairment, blood disorders or genetically inherited diseases or
congenital anomalies)
f. Day History/Social Profile
• woman’s current nutrition, elimination, sleep, recreation, and interpersonal interactions can
be elicited (typical day).
• Nutrition (“24-hour recall”)
• Type, amount, and frequency of exercise to determine a woman’s routine pattern.
• Recreational activity/hobby (hiking, camping, biking).
g. Gynecologic History
- A woman’s past experience with her reproductive system may have some influence on how
well she accepts a pregnancy so obtain information about her age of menarche (first
menstrual period) and how well she was prepared for it as a normal part of life.
• Ask about her usual cycle, including the interval, duration, amount of menstrual flow, and
any discomfort she feels.
• Aside from Breast Self-Examination, women should be taught on the need for medical
consultation and mammogram when they reached the 40 yrs of age. (Ruhl, 2007)
h. Obstetric History
• For each previous pregnancy, document the child’s sex and the place and date of birth.
A more comprehensive system for classifying pregnancy status (GTPAL or GTPALM)
provides greater detail on a woman’s pregnancy history. By this system, the gravida
classification remains the same, but para classification is broken down into:
T: Number of full-term infants born (infants born at 37 weeks or after)
P: Number of preterm infants born (infants born before 37 weeks)
A: Number of spontaneous miscarriages or therapeutic abortions
L: Number of living children
M: Multiple pregnancies
i. Review of Systems
• A review of systems completes the subjective information.
• Use a systematic approach, such as head to toe.
• A review of systems helps women recall concerns they forgot to mention earlier
PHYSICAL EXAM
1. Mc Donald’s rule
1. Mc Donald’s rule – method of determining that the fetus is growing in uterus by measuring
Fundal Height.
AOG IN MONTHS: FH (cm) x 2/7
AOG IN WEEKS: FH (cm) x 8/7
2. NAEGELE’S RULE
2. standard way of calculating the due date for a pregnancy when assuming a gestational age
of 280 days at childbirth.
1. Discomforts of Early Pregnancy:
The First Trimester
- Early pregnancy symptoms can often cause discomfort in an expectant woman.
- Providing empathic and sound advice about measures to relieve these discomforts helps
promote overall health and well-being.
a. Breast Tenderness.
- Breast tenderness is often one of the first symptoms noticed in early pregnancy. - Encourage
a woman to wear a bra with a wide shoulder strap for support and to dress warmly to avoid
cold drafts if cold increases symptoms.
b. Palmar Erythema.
- Palmar erythema, or palmar pruritus, occurs in early pregnancy and is probably caused by
increased estrogen levels.
- Calamine lotion can be soothing.
c. Constipation.
- As peristalsis slows and the weight of a growing uterus presses against the bowel,
constipation can occur.
- If dietary measures and attempts at regular bowel evacuation fail, a stool softener, such as
docusate sodium (Colace), or evacuation suppositories, such as glycerin, may be prescribed.
d. Nausea, Vomiting, and Pyrosis.
- At least half of pregnant women experience other gastrointestinal symptoms such as nausea,
vomiting, and pyrosis (heartburn).
e. Fatigue.
- Fatigue is extremely common in early pregnancy, probably because of increased metabolic
requirements.
f. Muscle Cramps.
- Decreased serum calcium levels, increased serum phosphorus levels, and, possibly,
interference with circulation commonly cause muscle cramps of the lower extremities during
pregnancy.
- Advised to take magnesium citrate or aluminum hydroxide gel (Amphojel).
- Lowering milk intake and take supplement: calcium lactate.
- Pregnant women also have a higher incidence of “restless leg syndrome” (waking at night
because of spontaneous leg movement) than non-pregnant women. ( No medications needed)
g. Hypotension.
- Supine hypotension is a symptom that occurs when a woman lies on her back and the uterus
presses on the vena cava, impairing blood return to her heart.
- Irregular heart rate and a feeling of apprehension.
h. Varicosities.
- Varicosities, or the development of tortuous leg veins, are common in pregnancy because
the weight of the distended uterus puts pressure on the veins returning blood from the lower
extremities.
i. Hemorrhoids.
- Hemorrhoids (varicosities of the rectal veins) occur commonly in pregnancy because of
pressure on these veins from the bulk of the growing uterus (Quijano & Abalos, 2009).
- Assuming a knee–chest position for 10 to 15 minutes. (less pressure on rectum)
