Assessment in Obstetrics for nursing school

assessment in obstetrics

1. Assessment in Obstetrics

2. Objectives Review the Antepartum/Intrapartum assessment Triage Questions Fetal Strip Labs Hands on: Cervical Checks Review Intrapartum assessment Magnesium checks Review Postpartum Assessment

3. Physiologic Changes In Pregnancy

4. Initial Assessment Initial Reason Gestational Age/How many babies? Medical and Obstetric History Famous Triage Questions: Contractions Leakage of Fluid Vaginal Bleeding Fetal Movement Headaches, Vision Changes, RUQ pain

5. Initial Fetal Strip >23+6 need EFM 20-23+6 need doppler Non-Stress Test

6. Labs Sterile Speculum Exam Preterm labor labs – Fetal Fibrinectin , GC/CT, GBS, Amnisure /Rom+ Serum – T&S, CBC – all admitted patients

7. Cervical Exams: Dilation

8. Cervical Exam: Effacement

9. Cervical Exam: Station

10. Case Study: Antepartum History of Present Problem: Anne Jones is a 17-year-old Caucasian teenager who thinks she may be pregnant because she has missed two periods. Her last menstrual period, she thinks, was about one month ago. She states she had a little bit of spotting last week but didn’t have a “full period”. She complains of her breasts being tender, swollen, frequent urination, and nausea in the morning. This is her first office visit and she is not sure why she feels so crummy but suspects she might be pregnant. Her urine pregnancy test is positive. Her primary care provider orders a prenatal lab panel and a urinalysis. Personal/Social History: Anne is a senior in high school who stands on her feet while working at McDonalds after school. She drinks six colas daily, denies alcohol use, and does not smoke. She takes no medications except for occasional acetaminophen for headaches and ibuprofen for menstrual cramps. Anne is 5’4” (160 cm) and weighs about 105 lbs. (47.7 kg) according to Anne. A 24-hour recall nutrition history reveals a typical day’s diet: breakfast- pop tart and can of cola; Lunch- a slice of pizza, chocolate chip cookie, can of cola; Dinner- fried chicken, green beans, biscuit, can of cola; snacks, including cookies and can of cola. She broke up last week with her boyfriend, and he is not aware she might be pregnant. She wants to keep the baby but has not told her parents.

11. Assessment

12. Labs

13. Plan of Care for Anne What are priorities in her care?

14. Anne Returns History of Present Problem: Anne is a 17-year-old, gravida 1 para 0 who is 39 weeks gestation and admitted to the labor room for observation at 1200. She began having contractions three hours ago at 8 to 10-minute intervals with each contraction lasting 30 seconds. She states her pain is 3/10. Her membranes are intact. On admission, a vaginal exam indicates cervical dilation is 1 cm, 80% effacement, and 0 station. After two hours of observation, her cervix is 2-3 cm/ 80% effacement/0 station and contractions are now 4-5 minutes apart, lasting 60-70 seconds and pain remains 3/10. Fetal lie is longitudinal with a cephalic presentation. You have her prenatal records from her visits to the office. She is Group Beta Strep (GBS) positive and received antibiotics at 36 weeks. Her blood type is B-. Personal/Social History: Anne’s mother is with her. Anne is not married and the father of the baby is not involved. She appears to be relaxed although she states she is a bit nervous. She wants a natural non-medicated birth and her mother will help coach her. She plans on breastfeeding for “awhile”. She attended childbirth preparation classes with her mother.

15. Anne’s Fetal Strip

16. Anne’s Assessment

17. Hypertension in Pregnancy ( 2 of 2) Most common hypertensive disorders in pregnancy Gestational hypertension Preeclampsia and eclampsia Chronic essential hypertension Preeclampsia superimposed on chronic hypertension

18. Classification

19. Classification Eclampsia Seizure activity or coma in woman diagnosed with preeclampsia No history of preexisting pathology Eclamptic seizures can occur before, during, or after birth

20. Classification Chronic hypertensive disorders Present before the pregnancy or diagnosed before 20 weeks gestation Persists after pregnancy/birth No proteinuria

21. Classification ( 4 of 4) Chronic hypertension with superimposed preeclampsia Increases morbidity of mother and fetus Diagnosis Sudden increase in blood pressure that was previously controlled –OR-- New onset proteinuria or sudden, sustained increased proteinuria in client with proteinuria before conception or in early pregnancy

22. Care Management Identifying and preventing preeclampsia Physical examination LOC Respiratory assessment Dependent edema Pitting edema Deep tendon reflexes Clonus Symptoms: headaches, epigastric or RUQ pain, visual disturbances Laboratory tests Proteinuria — Not reliable test for preeclampsia - 24 hour collection is preferred NOTE: Electronic BP measurements are not interchangeable with manual measurements. Copyright © 2018 by Elsevier Inc. All rights reserved. 22

23. Postpartum Physiologic Changes The postpartum period is the interval between birth and return of reproductive organs to their nonpregnant state Referred to as puerperium or fourth stage of pregnancy Traditionally lasts 6 weeks, although this varies among women

24. Reproductive System and Associated Structures Uterus Involution process is the return of the uterus to a nonpregnant state following birth Progresses rapidly Fundus descends 1 to 2 cm every 24 hours 2 weeks after childbirth the uterus is no longer palpable Returns to a nonpregnant state by 6 weeks Subinvolution is the failure of uterus to return to nonpregnant state