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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.

• Antepartum - refers to the medical & nursing care


given to the woman between conception & onset of labor

• 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.

• 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."

• Gestation - is the period of time between conception and birth


during which the fetus grows and develops inside the mother's
womb.

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

• 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.

• 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 NORMAL FINDINGS CHANGES DURING PREGNANCY


• Skin is consistent with • Increased subdermal fat deposit along with
generic background thickening of the skin due to increase of estrogen
Integumentary System and varies from levels.
pinkish tan to ruddy • Acne may develop or improved.
dark tan or from light
• Increased sweat and sebaceous gland production.
to dark brown and
may have yellow or • Excessive oiliness/ dryness of the scalp at six weeks
olive of pregnancy.
overtones(depending • Spider nevi-acting red angiomas occurring on the
on race). face, neck, chest, arms, & legs due to increase
• Freckles and some estrogen level.
birthmarks may be • Pigmentation increases in the nipples, areolae,
noted. external genitalia and the gluteal.
• Hair can be black, • Develop melasma, or chloasma
brown, burgundy etc. • Lina nigra, or darkeningof the linea alba.
and evenly distributed, • Nevi, circumscribed
it covers the whole
• Pigmented areas of skin, maybe stimulated to
scalp (no evidence of
Alopecia), there are no grow.
parasites and the • Darkening of areola, nipples axillae, umbilicus &
amount is variable. It perineum
can be thick or thin, • Skin tags, molluscum fibrosum gravidarum, may
coarse or smooth and develop from epithelial hyperplasia.
neither brittle nor dry. • 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.
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• Facial hair may increase.

Sensory System • Eyeballs are aligned • Corneal thickening and edema.


normally in their • Nasal stuffiness, snoring, congestion and
sockets with no epistaxis,.
protrusion or sunken • Impaired hearing or fullness in the ears and
appearance. Looks
moist and glossy.
decreased sense of smell.
• The iris appears flat, • Increased vascularity, edematous and bleeding
with a round regular gums.
shape and even • Ptayalism, excessive secretion of saliva
coloration. • Vocal changes or cough.
• 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.
Respiratory System • Normally, the ratio of • Increased oxygen consumption and carbon
the AP diameter to the dioxide secretion.
transverse diameter is • Diaphragm elevates approximately 4cm
approx. 1:2-5:7. In • Movement of the diaphragm increases.
other words, the
normal adult is wider • Respiratory effort is diaphragmatic.
from side-side than • Thoracic cage relaxes and expands by 5-7cm.
front to back. • Tidal volume increases by 30-40%
• Bronchial breath • Physiological changes, an increased respiratory
sounds heard over rate, hyperventilation, or shortness of breath.
trachea; expiration is
longer than
inspiration.
• Full symmetric
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excursion; thumbs
normally separate to 3-
5 cm. equal expansion.
• Fremitus is normally
decreased over heart
and breast tissue.
Cardiovascular System
• There are no • Increase in lasma, blood volume increases by 30-
pulsations palpable 50%.
over aortic and • The mother’s heart lies more horizontally and
pulmonic areas. Apical
shifts upward and to the left along with the apical
has the loudest sound
and should be 60-80 impulse.
bpm. No murmurs • Heart rate increases by 10-15 bpm.
should be heard. • 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.

Gastrointestinal • The surface is uniform • Decreased tone and motility


System in color and in • Decreased bowel sound
pigmentation.
• Increased emptying time for the stomach and
Abdomen Flawless, no scars
present. No striae / intestines.
stretch marks present. • Increased flatulence and constipation
Few veins may be • Indigestion due to relaxation of esophageal
visible normally. sphincter, substituent reflux and slowed gastric
• Umbilicus is in the emptying.
midline and inverted • Nausea and vomiting are common
with no sign of
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discoloration or • Experience a separation of the rectus muscle of
hernia. the abdominal wall, known as diastasis recti.
• Normally shaped from
flat to rounded; hair
distribution is
diamond shape in
males and inverted
triangular shape in
Esophagus females. Tympany is
usually predominating • Peristalsis of the esophagus decreases and
because of air in the relaxes the lower esophageal sphincter.
stomach and
Stomach and intestines.
intestines • 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
• 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
Liver is more likely to crystallize.
• The liver is not
inflamed; not painful • Physically displaced by the enlarging uterus.
to touch and may feel
like a firm rectangular
ridge. Often it is not
palpable and you feel
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nothing firm.

Urinary system • • 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.

Musculoskeletal • Head position is • The thyroid gland may increase in size after
System centered in the approximately 12 weeks of gestation (although
midline, and the studies are conflicting as t o whether or not there
accessory muscles is and increase) related to the increase in
should be vascularity. This may result in a shift in thyroid
symmetrical.
tests.
• The torso and head are
• Widening of smphysis pubis at approximately 28-
upright; walking is
initiated in one smooth 32 bbecause of hormones relaxin and
rhythmic fashion. progesterone affects all joints in the pregnant
• Muscle shape maybe woman’s body
accentuated in certain • Increased pelvic mobility to accommodate vaginal
body areas such as delivery
limbs and upper torso
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but should be • Developing lordosis of the lumbar spine that
symmetrical and it would keeps the center of gravity over the legs
should feel smooth • Leg weakness
and firm.
• There is no involuntary
• Developing of muscle cramps, particularly in the
muscle movement. calves,Thighs and buttocks especially at night
• Normal muscle • Increase of shoe size as much as full size as
strength allows for pregnancy progresses because of edema and
complete voluntary relaxation foot joints.
range of joint motion • Increased of fat deposits throughout the body.
against both gravity
and moderate to full
resistance.
Neurological System • No unusual frequent • Headaches
or severe headaches, • Numbness and tingling
no head injury, • Seizure activity with no prior history may indicate
dizziness or vertigo,
seizures or tremors.
the delopment eclampsia, or seizures associated
• No weakness, with pregnancy- induced hypertension.
numbness, or tingling • Dizziness and lightheadedness may due to the
or difficulty fetus pressure on the vena cava.
inspeaking. • Lapses of memory and etiology is poorly
understood
Reproductive Organ • The skin over the • Enlarging uterus
mons pubis should be • The round and broad ligaments elongate to
clear except for nevi accommodate the growing fetus and may cause
and normal hair
the patient lower quadrant pain
distribution.
• Decrease fundal height ( lightening) it is due to
• Labia majora and
minora should appear the descent of the presenting of the fetal part into
symmetrical with a the pelvis
smooth to somewhat • Cervix experiences increases vascularity and
wrinkled, unbroken, increased friability or susceptibility to bleeding
slightly pigmented • Vaginal discharge increases and is typically of a
surface. white consistency.
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• There should be no
ecchymosis cyst,
excoriation, nodules,
Breasts swelling, rash or • Breast changes may include enlargement,
lesions. tingling and tenderness secondary to hormonal
• Clitoris is 2cm in
changes.
length and .5cm in
• The areolae may darken. The nipples may
diameter without
lesions. The urethral become darker and more erect.
opening is slitlike in • Colustrum, a thick, yellow discharge known as
appearance and early brest milk, maybe secreted as early as the
midline; it is free of 2nd trimester.
discharge, swelling or • Veins in the breast may become more apparent
redness and is about and blue as they become engorged from
the size of a pea. increased vascularization.
Normal vaginal
discharge is clear to
white and free of foul
Anus and Rectum odor.
• Common to have a • Decrease gas through intestinal tract tone and
slight asymmetry in mobility
size; often the left • Development of hemorrhoids
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.
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• The rectum should
accommodate the
index finger, there
should be good
sphincter tone at rest
with bearing down.
Hematological System • • 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.
Endocrine System • • Increase oxygen consumption and to fetal
metabolic demands may often lead to feeling of
warmth and hest tolerance
Renal System • • 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 : 23
October : 31
November : 30
December : 31
January : 31
February : 28
March : 31
April : 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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