THE
PREGNANCY
EXPERIENCE
Situation
Mr. and Mrs. Andrews visit the
clinic and tell the nurse that
Mrs. A has “missed two
menstrual periods, has urinary
frequency, and is tired all of the
time”.
First Prenatal Visit
 What
is the most important
thing that the nurse can do at
this first prenatal visit?
FIRST PRENATAL VISIT
 Most
important intervention for
the nurse is to:
MAKE THE PATIENT WELCOME !
Why?
(so the couple will continue with
prenatal care)
 Now
that the couple has
been welcomed to the
clinic, one of the first things
that must be done is to
confirm that Mrs. A is
pregnant.
 Mrs.
A says that she used a
home pregnancy test and the
results were positive.
 What
are some of the
advantages and
disadvantages of using home
pregnancy testing?
Confirm the Pregnancy
All tests rely on detection of HCG
Enzyme
Immunoassay
Tests
Pregnancy
Tests
Urine
Hemaagglutination
Inhibition
Tests
Radioimmune assay Tests
It is confirmed that Mrs.
Andrews is pregnant.
The nurse will continue with the
assessment of physiological
and psychological needs of the
family.
Assessment begins at the initial
visit and continues throughout
pregnancy.
Calculation of Gravida and Parity
 Obstetrical
Status
• Gravida = number of times
pregnant regardless of duration
or outcome
• Parity = number of deliveries
after the age of viability (20
weeks).
** It is not the number of babies
that come out, but the number
of deliveries of a pregnancy
Calculation of Gravida and Parity

Further Breakdown into TPAL
• T = Term
• P = Preterm
• A = Abortions
• L = Live births
Check Yourself !
The nurse obtained the following data from
Mrs. Andrews. She has five year old twins
that delivered at 35 weeks, a three year old
son that delivered at 39 weeks, had a
miscarriage last year at 12 weeks gestation.
What is her gravida and parity?
What is her gravida and parity using the
TPAL system?
Health
History
Assessment

Collect information about:
• Obstetric History -- Current and past pregnancies
• Menstrual History
• Family history--genetic and environmental factors that
affect health
• Medical history-- diabetes, heart

Perform Physical Examination including a
Pelvic Examination (Pap test, measurements,
cervical culture)

Perform Laboratory Studies
• Hgb., Hct, Type, Rh, CBC, Rubella, Hepatitis, HIV

Mr. and Mrs. Andrews are both excited about
the pregnancy. It is her first so she is
considered a Gravida 1, Para 0.

They ask the nurse “When is the baby due”?

How will you calculate this?
Calculation of E. D. C.
 Nagele’s Rule
 First day of last Menstrual
 Go back 3 months
 Add 7 days
 Mrs. Andrews tells you her last
menstrual period began on July 18.
 Her baby is due on ____________.
TEST YOURSELF
Mrs. B. began her menses on
January 21. What is her E.D.C.
using Nagele’s Rule?
Mrs. C. started her menses on
June 27. What is her E.D.C.
using Nagele’s Rule?
Problem Solving
 If
Mrs. Andrews did not know
the first day of her last
menstrual period, what
method of calculation would
you use?
 McDonald’s Rule
 Use Fundal height measurement,
measure from the symphysis to the
top of the fundus.
 Months = measure cm. X 2/7
 Weeks = measure cm. X 8/7
 Mrs. Andrew’s fundal height is
7 cm. How far along is she?
Assessment of Pelvic Adequacy

Clinical Pelvimetry via ultrasound can be
performed to determine if the pelvis is of
adequate size to allow for a normal vaginal
delivery.

Manual measurement via examiner
Assessment
 The
nurse continues with
assessment of Mrs. Andrews
and gathers data regarding
presumptive, probable, and
positive signs of pregnancy.
Presumptive Signs of Pregnancy








Cessation of Menstruation
Breast changes -- tenderness
Nausea and Vomiting
Frequent Urination
Quickening
Chadwicks sign
Increased pigmentation of the Skin
Fatigue
Probable Signs of Pregnancy







Enlargement of the Abdomen
Hegar’s Sign -- softening of the isthus of the uterus
Goodell’s Sign --softening of the cervix
Braxton-Hicks contractions
Ballotment
Outline of the fetus by abdominal palpation
Positive Pregnancy Test
Positive Signs of Pregnancy

Ausculation of fetal heart tones

Active fetal movement felt by Trained person

Ultrasound showing fetal outline
Conclusion of Visit

You are completed with Mr. and Mrs. Andrews
first prenatal visit.

Before they leave, it is important to discuss
the following topics:
Conclusion of Visit

Patient Teaching

Diet Counseling

Referrals

Danger Signals

Date of next visit
Danger Signals










Vaginal Bleeding
Fluid from the Vagina
Abdominal Pain
Increased Temperature
Dizziness, Blurred vision or Double Vision
Persistent Vomiting
Edema
Headache
Dysuria
Absence of Movement of the Baby
Chapter 11
Cultural Beliefs and Practices
In working with clients of other cultures,
health professionals should be open to and
respectful of other beliefs
Self Care

Employment
• Criteria for work:
– is work environment safe for the fetus
– can woman carry out work commitments without
undue stress\
 What
other teaching is necessary
regarding work and breaks.
Self Care

Mrs. Andrews says that she is
employed as a bank teller on a full time
basis.

She asks whether she can continue to
work throughout her pregnancy
Self Care

Exercise, Leisure
• May attend regular prenatal exercise
classes
• Don’t take up a new sport
• Travel--wear seat belt
Safety with Seat Belts
Wear shoulder belt
over top of abdomen
Wear lap belt low
over the hips
Self Care

Safety
• Clothing
• Bathing
• Immunizations - avoid live vaccines
Substance Abuse

Caution women against the use of
abusive substances
•
•
•
•
•

Tobacco
Alcohol
Caffeine
Marijuana
Cocaine
May need referral for further evaluation
These can all be teratogenic and lead to
various fetal complications
See pages 260-262
Sexual Changes

First Trimester
Decrease in desire

Second Trimester
Increase in desire

Third Trimester
Alterations needed by the couple
Intercourse contraindicated if woman has
history of preterm labor or ruptured
membranes
Nutrition in Pregnancy

Increase in calories
Increase in protein

May have food cravings or Pica

Nursing care:
• Teach to take prenatal vitamins and iron
• Teach about normal weight gain ~ 25 lbs.