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Chapter 23
Pregnant Patient
Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Describe the characteristics of the
most common pregnancy-related
complaints.
Assess the psychosocial status of
a pregnant woman.
Differentiate the normal changes
of pregnancy from pathological
changes.
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Copyright 2002, Delmar, A division of Thomson Learning
Competencies
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Perform a physical assessment on
a pregnant woman.
Assess the learning needs of a
pregnant woman.
Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
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Skin and hair
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Head and neck
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Alterations in pigmentation
Skin
Vascular
Enlarged thyroid gland
Eyes, ears, nose, mouth, and throat
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Visual changes
Nasal congestion
Copyright 2002, Delmar, A division of Thomson Learning
(continues)
Anatomy and
Physiology
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Breasts
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Early changes
Late changes
Thorax and lungs
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Increased oxygen consumption
Increased carbon dioxide excretion
Diaphragmatic breathing
Increased tidal volume
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Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
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Heart and peripheral vasculature
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Increased blood volume
Increased heart rate
Diastolic blood pressure changes
Abdomen
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Displaced abdominal organs
Decreased bowel sounds
Increased GI emptying time
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Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
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Urinary system
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Increased glomerular filtration rate
Urinary frequency
Increased risk for glycosuria,
proteinuria, nocturia
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Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
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Musculoskeletal system
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Widening of symphysis pubis
Unsteady gait
Lordosis
Neurological system
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Common changes include headache,
numbness, tingling
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Copyright 2002, Delmar, A division of Thomson Learning
Anatomy and
Physiology
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Female genitalia
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Uterine changes
Increased cervical vascularity and
friability
Hematological system
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Increased WBC
Increased RBC volume
Increased plasma volume
Decreased platelets
Copyright 2002, Delmar, A division of Thomson Learning
(continues)
Anatomy and
Physiology
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Anus and rectum
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Decreased GI tone and motility
Increased risk for hemorrhoids
Endocrine system
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Increased BMR
Increased resistance to insulin
Copyright 2002, Delmar, A division of Thomson Learning
Psychosocial Risk
Factors
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Abuse risk factors
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Frequent visits with vague
complaints
Injuries are inconsistent with
complaints
Fails to plan for baby’s arrival
Frequently misses appointments
Abuse crosses all socioeconomic
groups
Copyright 2002, Delmar, A division of Thomson Learning
Health History
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Age
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Race
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Greater risk for complications
associated with woman < 17 or > 35
Increased risk for hypertension and
preterm delivery in African Americans
Common chief complaints
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
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Medical history
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Surgical history
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Presence of chronic disease
Uterine, cervical, or abdominal
surgeries
Medications
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Prescribed
Over the counter
Risk for teratogenic effect
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(continues)
Past Health History
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Communicable diseases
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Mumps
Measles
Rubella
Varicella
Toxoplasmosis
CMV
Allergies
Injuries/accidents
Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
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Special needs
Childhood illnesses
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Rheumatic heart disease
Immunizations
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Typically avoided during pregnancy
May receive hepatitis B series during
pregnancy
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Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
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Family history
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Maternal
Paternal
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Copyright 2002, Delmar, A division of Thomson Learning
Past Health History
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Social history
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Substance use
Sexual practices
Travel history
Work environment
Home environment
Hobbies/leisure activities
Stress
Ethnic background
Copyright 2002, Delmar, A division of Thomson Learning
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Past Health History
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Health maintenance activities
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Sleep
Diet
Exercise
Use of safety devices
Health checkups
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Obstetric History
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Present
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LMP
History since LMP
S & S of pregnancy
Use of fertility drugs
Due date
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Obstetric History
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Past
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Complications
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Type of
delivery
Breastfeeding
difficulties
Gravida, para
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Length of labor
Abortions

Infant gender,
weight, Apgar
score
Multiple births
Living children
Copyright 2002, Delmar, A division of Thomson Learning
Assessment
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Equipment
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Stethoscope
Fetoscope
Urine specimen supplies
Tape measure
General approach
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Privacy
Quiet environment
Copyright 2002, Delmar, A division of Thomson Learning
Physical Assessment
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General assessment, vital signs,
weight
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Close monitoring of blood
pressure and weight changes
Skin and hair
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Pigment, skin, vascular changes
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Physical Assessment
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Head and neck
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Eyes, ears, nose, mouth, and throat
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Thyroid function
Visual changes
Status of oral mucosa
Breasts
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Shape of nipples and areola
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Physical Assessment
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Thorax and lungs
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Heart and peripheral vasculature
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Breath sounds
Diaphragmatic breathing
Heart sounds
Presence of edema
Abdomen
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Physical Assessment
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Urinary system
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Uterine size
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Urinalysis
Urine culture
Fundal height
Musculoskeletal system
Neurological system
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Abnormal findings include seizures,
eclampsia, hyperreflexia
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Physical Assessment
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Female genitalia
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Fetal heart rate
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Uterine size appropriate for gestational age
Uterine and cervical changes
Doppler
Fetoscope
Normal rate is between 110 to 160 bpm
Leopold’s maneuver
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Determine fetal presentation
Copyright 2002, Delmar, A division of Thomson Learning
(continues)
Physical Assessment
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Hematological system
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Prenatal panel
Endocrine system
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Glucose screen
Glucose is abnormal if results
are > 130 to 140 mg/dl or 120
mg/dl after meals
Copyright 2002, Delmar, A division of Thomson Learning
Common Antepartum
Tests
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Ultrasound
Genetic testing
Nonstress test
Amniotic fluid volume
Biophysical profile
Fetal movement count
Copyright 2002, Delmar, A division of Thomson Learning
Danger Signs of
Pregnancy
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Vaginal bleeding
Leaking or gush of watery fluid
Abdominal or pelvic pain
Severe headache or blurred vision
(continues)
Copyright 2002, Delmar, A division of Thomson Learning
Danger Signs of
Pregnancy
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Persistent chills or fever > 102°F
Persistent vomiting
Decreased fetal movement or
lack of fetal movement
Change in vaginal discharge
Frequent uterine contractions
Copyright 2002, Delmar, A division of Thomson Learning
Psychosocial
Assessment
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Feelings about pregnancy
Mood changes
Adaptation to pregnancy
Assess age, prior history, family
history
Shift from focus on self to focus
on the fetus’s well-being
Copyright 2002, Delmar, A division of Thomson Learning
Learning Needs
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Consider social services consultation
Provide appropriate educational
materials
Topics
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What to expect during pregnancy
Self-care
Follow-up health needs
Infant care
Copyright 2002, Delmar, A division of Thomson Learning