Asses Pregnancy

Assessment In Pregnancy

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Members: Ayes, Monique Busbos, Christina Mae Busa, Ana Marie Cabiltes, Claitte Canson, Clofel lyne Ceniza, Marjorie ann Diano, Kristine Joy Gallogo, Saira Shade

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ASSESSMENT in PREGNANCY

I. Definition of Terms:

1. Pregnancy 2. Antepartum 3. Gestation 4. Last Menstrual Period (LMP) 5. Age of Gestation (AOG) 6. Expected Date of Confinement

II. Prenatal Maternal Assessment

III. Identify Alterations in Computing for AOG & EDC 1. McDonald’s Rule 2. Naegele’s Rule

IV. Compute AOG (Tinamban Style)

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I. DEFINITION OF TERMS: •

Pregnancy - (latin graviditas) is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Human pregnancy is the most studied of all mammalian pregnancies.

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Antepartum - refers to the medical & nursing care given to the woman between conception & onset of labor

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Antenatal Care – is the routine care that all healthy women can expect to receive during their pregnancy. Ensuring the overall health of newborns and their mothers and helping to reduce the low-birthweight babies born each year.

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Parturition - Childbirth, the process of delivering the baby and placenta from the uterus to the vagina to the outside world. It is also called labor and delivery. Parturition comes from the Latin parturire, "to be ready to bear young" and is related to partus, the past participle of parere, "to produce."

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Gestation - is the period of time between conception and birth during which the fetus grows and develops inside the mother's womb.

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Last Menstrual Period – Refers to the first day of your last period before conception occurred. Is used to calculate the baby's due date.

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Age of Gestation – it is the time measured from the first day of the woman's last menstrual cycle to the current date. It is measured in weeks. A normal pregnancy can range from 38 to 42 weeks.

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Expected date of Confinement – reflecting the notion of the mother being confined to a specific area for delivery. Is an archaic term for the estimated date a baby might be born. It is determined

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based on the first day of a woman's last menstruation. Is also called Estimated Date of Delivery or Estimated Due Date (EDD). •

Prenatal Maternal Assessment – the assessment focuses on the woman holistically by considering physical, cultural and psychosocial factors that influence her health.

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II. PRENATAL MATERNAL ASSESSMENT (Review of Systems) SYSTEMS

CHANGES DURING PREGNANCY

NORMAL FINDINGS •

Integumentary System

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Skin is consistent with generic background and varies from pinkish tan to ruddy dark tan or from light to dark brown and may have yellow or olive overtones(depending on race). Freckles and some birthmarks may be noted. Hair can be black, brown, burgundy etc. and evenly distributed, it covers the whole scalp (no evidence of Alopecia), there are no parasites and the amount is variable. It can be thick or thin, coarse or smooth and neither brittle nor dry.

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Increased subdermal fat deposit along with thickening of the skin due to increase of estrogen levels. • Acne may develop or improved. • Increased sweat and sebaceous gland production. • • •

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Excessive oiliness/ dryness of the scalp at six weeks of pregnancy. Spider nevi-acting red angiomas occurring on the face, neck, chest, arms, & legs due to increase estrogen level.

Pigmentation increases in the nipples, areolae, external genitalia and the gluteal. Develop melasma, or chloasma Lina nigra, or darkeningof the linea alba. Nevi, circumscribed Pigmented areas of skin, maybe stimulated to grow. Darkening of areola, nipples axillae, umbilicus & perineum

• Skin tags, molluscum fibrosum gravidarum, may develop from epithelial hyperplasia. • Striae ( strech marks ) develops in the breasts, and upper thighs • Vascular changes reflected that can include the development or enlargement of spider angiomas, hemangiomas, varicosities. 6

Sensory System

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Respiratory System

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Eyeballs are aligned normally in their sockets with no protrusion or sunken appearance. Looks moist and glossy. The iris appears flat, with a round regular shape and even coloration. Nose is Symmetric, no deformities, or skin lesions. Mucusa is pink, no discharge, no septal deviation or perforation. Mouth has no lesions, bleeding gums, toothache, obstruction, epistaxis or allergy. Normally, the ratio of the AP diameter to the transverse diameter is approx. 1:2-5:7. In other words, the normal adult is wider from side-side than front to back. Bronchial breath sounds heard over trachea; expiration is longer than inspiration. Full symmetric

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Facial hair may increase.

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Corneal thickening and edema. Nasal stuffiness, snoring, congestion and epistaxis,. Impaired hearing or fullness in the ears and decreased sense of smell. Increased vascularity, edematous and bleeding gums. Ptayalism, excessive secretion of saliva Vocal changes or cough.

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Increased oxygen consumption and carbon dioxide secretion. Diaphragm elevates approximately 4cm Movement of the diaphragm increases. Respiratory effort is diaphragmatic. Thoracic cage relaxes and expands by 5-7cm. Tidal volume increases by 30-40% Physiological changes, an increased respiratory rate, hyperventilation, or shortness of breath.

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Cardiovascular System

Gastrointestinal System

excursion; thumbs normally separate to 35 cm. equal expansion. Fremitus is normally decreased over heart and breast tissue.

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There are no pulsations palpable over aortic and pulmonic areas. Apical has the loudest sound and should be 60-80 bpm. No murmurs should be heard.

• Increase in lasma, blood volume increases by 3050%. • The mother’s heart lies more horizontally and shifts upward and to the left along with the apical impulse. • Heart rate increases by 10-15 bpm. • Increased breast vascularization may lead to contiuous murmur “ mammary soufflé”. • Supine hypotension • Systolic pressure is not significantly whereas the diastolic pressure may lower by 5mmHg. • Experiencing dependent edema due to peripheral vasodilation and decreased vascular resistance. • Swelling is most commonly seen in the feet but can also occur in the hands and face.

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The surface is uniform in color and in pigmentation. Flawless, no scars present. No striae / stretch marks present. Few veins may be visible normally. Umbilicus is in the midline and inverted with no sign of

• Decreased tone and motility • Decreased bowel sound • Increased emptying time for the stomach and intestines. • Increased flatulence and constipation • Indigestion due to relaxation of esophageal sphincter, substituent reflux and slowed gastric emptying. • Nausea and vomiting are common

Abdomen

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Esophagus

Stomach and intestines

discoloration or hernia. Normally shaped from flat to rounded; hair distribution is diamond shape in males and inverted triangular shape in females. Tympany is usually predominating because of air in the stomach and intestines.

• Experience a separation of the rectus muscle of the abdominal wall, known as diastasis recti.

• Peristalsis of the esophagus decreases and relaxes the lower esophageal sphincter. • Bowel sound may not be evident in the four normal quadrants • Appendix may be found as high as the right flank • Changes in the tone of the stomach delayed • Emptying may contribute the early nausea and vomiting.

Gallbladder •

Liver

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The liver is not inflamed; not painful to touch and may feel like a firm rectangular ridge. Often it is not palpable and you feel

Acid production in the stomach is decreased • Effect of progesterone on smooth muscle also decreases the tone and motility • The cholesterol in the bile of the pregnant woman is more likely to crystallize. • Physically displaced by the enlarging uterus.

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nothing firm.

Urinary system

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Musculoskeletal System

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• Glomerular filtration rate GFR increase by approximately 50% and reabsorption rate of various chemical especially sodium and water changes • Urinary frequency usually increases in the 1st trimester. • Glycosuria glucose in the urine is common in pregnancy. • There is also an increase loss of amino acid they may show as protienuria on a urine dipstick • Dilation of ureters and renal pelvises, decreased in bladder tone, and short female urethra plays the pregnant woman at risk for urinary tract infection. • Nocturia or excessive night time urination, may disrupt the pregnant woman’s sleep pattern.

Head position is centered in the midline, and the accessory muscles should be symmetrical. The torso and head are upright; walking is initiated in one smooth rhythmic fashion. Muscle shape maybe accentuated in certain body areas such as limbs and upper torso

• The thyroid gland may increase in size after approximately 12 weeks of gestation (although studies are conflicting as t o whether or not there is and increase) related to the increase in vascularity. This may result in a shift in thyroid tests. • Widening of smphysis pubis at approximately 2832 bbecause of hormones relaxin and progesterone affects all joints in the pregnant woman’s body • Increased pelvic mobility to accommodate vaginal delivery 10

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Neurological System

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Reproductive Organ

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but should be symmetrical and it should feel smooth and firm. There is no involuntary muscle movement. Normal muscle strength allows for complete voluntary range of joint motion against both gravity and moderate to full resistance. No unusual frequent or severe headaches, no head injury, dizziness or vertigo, seizures or tremors. No weakness, numbness, or tingling or difficulty inspeaking. The skin over the mons pubis should be clear except for nevi and normal hair distribution. Labia majora and minora should appear symmetrical with a smooth to somewhat wrinkled, unbroken, slightly pigmented surface.

• Developing lordosis of the lumbar spine that would keeps the center of gravity over the legs • Leg weakness • Developing of muscle cramps, particularly in the calves,Thighs and buttocks especially at night • Increase of shoe size as much as full size as pregnancy progresses because of edema and relaxation foot joints. • Increased of fat deposits throughout the body.

• Headaches • Numbness and tingling • Seizure activity with no prior history may indicate the delopment eclampsia, or seizures associated with pregnancy- induced hypertension. • Dizziness and lightheadedness may due to the fetus pressure on the vena cava. • Lapses of memory and etiology is poorly understood • Enlarging uterus • The round and broad ligaments elongate to accommodate the growing fetus and may cause the patient lower quadrant pain • Decrease fundal height ( lightening) it is due to the descent of the presenting of the fetal part into the pelvis • Cervix experiences increases vascularity and increased friability or susceptibility to bleeding • Vaginal discharge increases and is typically of a white consistency. 11

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Breasts •

Anus and Rectum

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There should be no ecchymosis cyst, excoriation, nodules, swelling, rash or lesions. Clitoris is 2cm in length and .5cm in diameter without lesions. The urethral opening is slitlike in appearance and midline; it is free of discharge, swelling or redness and is about the size of a pea. Normal vaginal discharge is clear to white and free of foul odor. Common to have a slight asymmetry in size; often the left breast is slightly larger than the right. The anal mucosa is deeply pigmented, coarse, moist and hairless. It should be free of lesions, inflammation, rashes, masses or additional openings. The anal opening should be closed and no leakage of feces or mucus from the anus.

• Breast changes may include enlargement, tingling and tenderness secondary to hormonal changes. • The areolae may darken. The nipples may become darker and more erect. • Colustrum, a thick, yellow discharge known as early brest milk, maybe secreted as early as the 2nd trimester. • Veins in the breast may become more apparent and blue as they become engorged from increased vascularization.

• Decrease gas through intestinal tract tone and mobility • Development of hemorrhoids

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Hematological System

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Endocrine System

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Renal System

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The rectum should accommodate the index finger, there should be good sphincter tone at rest with bearing down.

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Increase white blood cells Increase total red blood cells volume Increase plasma volume Decrease number and increase size of platelets Increase fibrinogen and clotting factors VI-X. Increase oxygen consumption and to fetal metabolic demands may often lead to feeling of warmth and hest tolerance • Increase glumerular filtration rate and renal plasma flow • Increase urinary output and decreases edema • The woman’s kidneys must manage the increase metabolic and circulatory demands of the, maternal body and the excretion of fetal waste product.

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III. IDENTIFY ALTERNATIVES IN COMPUTING FOR AOG & EDC A. NAEGELE’S RULE (Expected date of confinement) Formula: (1st day of LMP) + 7 days – 3 months + 1 year Example 1: LMP: 10 July, 2006 10 7 06 +7- 3+ 1 17 4 07 Thus, EDC: 17th of April 2007 Example 2: LMP: 31 January, 2008 31 01 08 + 7 - 3 +0 38 10 08 -31 + 1 +0 7 11 08 Thus, EDC: 7th of November 2008 Note: - January to March 24 (Add 12 to months) - March 25 – December (add 1 to the year) B.MCDONALD’S RULE (Estimation of the duration of the pregnancy) -

estimation using the fundic height fundal height (measured from symphisis pubis to top of uterus) used to app. Fetal age (in weeks) application from 22-34 weeks age of gestation

FORMULA: # of cm x 8/7 = wks gestation # of cm x 2/7 = duration of pregnancy in months Note: inaccurate in 3rd trimester

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IV. COMPUTATION OF AGE OF GESTATION (AOG) (TINAMBAN STYLE) For Example: Last menstrual period (LMP): September 7-12, 2008 Assessment date: April 21, 2009 LMP: September: 30 - 7 23

September October November December January February March April

: 23 : 31 : 30 : 31 : 31 : 28 : 31 : 21 226

AOG: __32_r.2 7│226 21 16 14 2 __8_ 4│32 32 x AOG= 8 months 2weeks 0 days

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