MCN-107-PPT.pptx.NURSING.second year. Mcn_107

MCN 107

1. MCN 107 ALTERNATIVE LEARNING EXPERIENCE About this deck Office 365 subscribers can add 3D models to documents and rotate the angle to show the right view. If you don’t have a subscription, the deck simply shows a single view.

2. Components of Health History 1. Demographic data (name, age, address, gender, marital status, educational level, occupation, religion and health insurance information) 2. Chief concern: is the reason why a woman visits the health care setting. This is related to the fact that she is or thinks she is pregnant. 3. Present health history 4 . Past health history : woman’s past medical history including diseases that may cause potential difficulty during pregnancy (e.g. heart disease, hypertension, diabetes, kidney disease, thyroid disease, urinary tract infection, varicosities, tuberculosis, asthma, STIs including Hepatitis B and C, herpes and HIV, childhood diseases and immunizations) 5. Family health history : illnesses that occur among woman’s relatives (hereditary diseases like cardiovascular and renal disease, blood disorders cognitive impairment and congenital anomalies or diseases inherited genetically) ASSESSMENT

3. A. Menstrual history : age of menarche, length of menstrual cycle, duration and amount of menstrual flow, any accompanying discomforts and menstrual pain. Menarche: is the first menstrual period Menopause: cessation of menstrual cycles Amenorrhea: absence of menstruation Dysmenorrhea: painful menstruation Menorrhagia: abnormally heavy menstrual flows Metrorrhagia: bleeding between menstrual periods Oligomenorrhea: scanty or very light menstruation 6. Gynecologic history:

4. B. Perineal and Breast Self-Examination Perineal self-examination: inspecting the external genitalia monthly for signs of infection or lesions Breast self-examination: monthly self-care routine C. Past surgery: involves previous surgery on the reproductive tract which may influence the ability of a woman to conceive and give birth D. Reproductive planning E. Sexual history **Note: Abdominal examination is included

5. 7. Obstetric history : includes previous pregnancy (when? type of delivery? outcome of birth?), previous miscarriage or therapeutic abortions. Classifying pregnancy status (OB Score) GTPAL or GTPALM : provides information on woman’s history of pregnancy

6. G: the number of times a woman has been pregnant, including the present pregnancy (Gravida status) P: the number of children over the age of viability that a woman has previously delivered (Para status) T : the number of full-term infants born at 37 weeks or after P: the number of preterm infants born before 37 weeks A : the number of spontaneous miscarriage or abortion L : the number of living children GTPAL

7. TERM DEFINITION Para Number of pregnancies that have reached viability, regardless of whether the infants were born alive Gravida Woman who is or has been pregnant. Primigravida Woman who is pregnant for the first time. Primipara Woman who has given birth to one child past age of viability. Multigravida Woman who has been pregnant previously. Multipara Woman who has carried two or more pregnancies to viability. Nulligravida Woman who has never been and is not currently pregnant. Definition of terms related to pregnancy

8. Viability The ability of the fetus to survive in extra-uterine condition (20 weeks gestation)  Age of fetus ≥ 20-24 weeks  Weighs at least 500g  Length ≥ 18cm Term pregnancy A pregnancy of 38 – 42 weeks Preterm pregnancy It occurs before the end of 37 weeks of gestation Postterm pregnancy (Postmature or postdate) Datism A pregnancy that exceeds from 42 week Abortion is the medical term for any interruption of pregnancy before a fetus is viable Miscarriage Early: Termination of pregnancy before 16th week Late: Termination of pregnancy between 16th -24th weeks

9. 8. Psychosocial aspect- social support system 9. Laboratory result (CBC, Blood group and RH Factor, HCG, urinalysis, ultrasound) 10. Current medication or treatment 11. Functional health history/History of daily activity: information regarding woman’s current nutrition, elimination, sleep, activity or exercise, personal habits, lifestyle, recreation, and interpersonal interactions 1 2. Physical examination A. Assessment of Body Systems B. Height/Weight and Vital Signs: Naegele’s is a method used for calculating the estimated Expected Date of Delivery/Expected Date of Confinement (EDD/EDC) based on Last Menstrual Period (LMP)

10. BMI (Body Mass Index) = (weight per kg) / (Height per meter) ² Calculation of Body Mass Index: TOTAL WEIGHT GAIN DURING PREGNANCY (Body Mass Index – BMI) *Institute of medicine (IOM) and National Research Council (NRC), 2009 (weight per kg/Height per meter2) Range of Total Weight Gain ( lb ) Single Fetus Underweight: BMI is less than 18.5 28-40 Normal weight: BMI is 18.5 to 24.9 25-25 Overweight: BMI is 25 to 29.9 15-25 Obese: 11-20

11. Weight gain during 1st trimester: 0.8kg (1.5 lbs ) per month ; 0.4 kg (1 lb ) per week during the last two trimesters (minimum weight gain 4.5 lbs , 12 lbs and 12 lbs for the trimester) Normal weight gain during pregnancy is 11.3-15.8 kg (25 – 35 lbs ) Note:

12. Neagel’s Rule: Example: Last Menstrual Period: December 18, 2023 Month Day Year 12 18 2023 - 3 + 7 + 1 _____________________________________________ 8 25 2024 Expected date of Delivery is: August 25, 2024 EDC (Expected Dated of Confinement

13. Example# 2 Last Menstrual Period: January 15, 2023 Month Day Year 1 15 2023 + 9 + 7 +0 ____________________________________________ 10 22 2023 Expected date of Delivery is: October 22, 2023

14. Example: Mrs Vila visits her physician today because of uncomfortable feelings like morning discomfort and body malaise. The Nurse took vital signs and asked her some question: Nurse: When was your last menstrual period? Mrs Vila: April 11, 2021. Compute for the EDC. Example: A patient was rushed in the emergency room complaining of minimal vaginal bleeding and she stated that she is pregnant. As interviewed her LMP is January 6, 2021. Compute for the EDC. Example: LMP- August 14, 2021 LMP- March 27, 2021 LMP- December 25, 2020

15. Abdominal examination General Guidelines: Empty bladder Measure fundal height (measure growth of fetus) Provide privacy Use inspection and palpation Documentation AOG Age of Gestation Computation

16. Inspect the woman’s abdomen for its shape. This can indicate fetal size and lie, the amount of amniotic fluid and sometimes fetal movement may be noticed. Obvious scars will be seen and this information may be significant Inspection:

17. Gestational age Fundal height 40 weeks 1-2 finger widths below subcostal arch (Normally, due to settling of the fetus into the midpelvis , known as Lightening) 36 weeks Usually touches the xiphoid process 32 weeks Between umbilicus and xiphoid process 28 weeks 3 finger widths above umbilicus 24 weeks Just above the level of umbilicus 20 or 22 weeks At the level of umbilicus 16 weeks Between symphysis pubis and umbilicus 12 weeks Just above the symphysis pubis

18. AOG Age of Gestation Computation

19. Bartholomew’s Rule

20. Breast Care

21. Abdominal Assessment

22. Fetal Heart Tone Monitoring

23. Pelvic size

24. Laboratory Assessment