CARING FOR THE PREGNANT CLIENT

ASSESSMENT

Health History (Biographical Information)

Name(family name, first then middle name) Address(permanent and official), phone number and persons to be contacted in case of emergency Birth date, age, sex, ethnic origin/race Place of birth Marital status Religion Occupation(usual and present) Educational status

Family Profile/Family History

Ask about marital status Know size of apartment or home (ie: need to climb stairs, room for baby etc) Know her age and sexual partners age Educational level Occupation Communicable diseases suffered by other members of the family whom the pregnant woman lives with(ie: measles, TB etc) Pregnancy and delivery difficulties and complications experienced by the pregnant womans mother

Past Medical History

Diseases that can pose difficulty during pregnancy include kidney disease, heart disease, HPN,STI (Hep .HIV)DM, thyroid disease, gallbladder disease, UTI,PKU,TB,asthma. Childhood diseases-mumps, chickenpox(varicella),mumps(parotitis),measles(rubeola), german measles(rubella),poliomyelitis. Allergies and drug sensitivities including food allergy Past surgeries

Social Profile
1. Nutrition 2. Exercise 3. Hobbies 4. Smoking 5. Recreational drugs 6. Alcohol intake 7. Partner abuse 8. Medication history

Gynecologic History
Menarche age and how well she was prepared for it Menstrual cycle interval,duration,amount of low, any discomfort-how long,degree,when it occurs relief Monthly perineum self examination BSE Past surgery on the reproductive tract tubal surgery Reproductive planning method IUD, Oral pill Sexual history Assess for possibility of stress incontinence

Obstetric History
Past pregnancies Previous miscarriages or abortions and complications OB Scoring Gravida Para/Parity 2 Methods of Scoring: 1. Gravida-Para (GP) 2. GP TPAL Method or GP TPALM

DETERMINING EDC
NAEGELES RULE A method used to determine or calculate the date of birth of the infant or expected date of confinement (EDC) for the delivery of the mother. A standard method used to predict the length of the pregnancy.

DETERMINING AOG
AOG in weeks= Fundal Height (FU in cm)x 8/7 DURATION OF PREGNANCY IN LUNAR MONTHS= Fundic height (FU in cm) x 2/7 LMP known by mother

PRENATAL CARE
Purpose of prenatal: Risk for Complications pregnant mothers must be identified Establish a baseline of present health Monitor fetal development Age of Gestation Time for education about pregnancy, lactation and newborn care Anticipating and preventing problems before they occur to minimize risk of possible complications Low birth weight babies reduced

Physical Assessment

LEOPOLDS MANEUVER

Leopold maneuver
Leopold maneuver is established by Leopold in1848 Preparations before examination
Instruct woman to empty her bladder first. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. Drape properly to maintain privacy Explain procedure to the patient. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). Use the palm for palpation not the fingers

Purpose
to assess position of baby determine fetal heart rate to know if the head is already engaged

 First Maneuver:
To determine fetal part lying in the fundus. To determine presentation. procedure: Using both hands, feel for the fetal part lying in the fundus. Head is more firm, hard and round, and is more mobile and ballottable. Breech feels as a large, nodular mass.

 Second Maneuver:
To identify location of fetal back. To determine position. Procedure: One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. Use gentle but deep pressure. Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feels with a number of small, irregular, mobile parts

 Third Maneuver:
To determine engagement of presenting part. procedure: Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side. The presenting part is engaged if it is not movable. It is not yet engaged if it is still movable

 Fourth Maneuver:
To determine if the presentation has descended into the pelvis To determine the position of the fetal presentation procedure: Facing foot part of the woman, using the tips of the first three fingers, exerts deep pressure in the direction of the axis of the pelvic inlet Use both hands.

Fundal Height