Assessment in Pregnant women and psychosocial status.
I need to write a page response to both of these \”papers\” on Assessments on Pregnant women. Respond what you liked in the post, add informative information to continue the discussion with at least 1 source for each
PAPER 1
The difference between taking care of an antepartum patient versus an ill patient is that our focus is on promoting and maintaining a healthy pregnancy, whereas when caring for an ill patient our focus is on improving their health. In the beginning of antepartum care, we would assess and identify patients who may be at risk for complications. Some of those risk factors include maternal age, existing chronic illnesses, past pregnancy history, and current lifestyle. As a nurse, we would promote a healthy lifestyle and self-care to an antepartum patient. We would encourage such things as maintaining regular prenatal visits, taking folic acid daily to prevent birth defects, regular exercise, abstaining from drugs and alcohol, eating a safe and healthy diet by avoiding raw fish, undercooked and deli meat, and unpasteurized cheeses.
During the initial prenatal visit, we would provide a physical examination to the antepartum patient. We would estimate the gestational age. One way to do so is by using Nageles Rule. Nageles Rule is a standard way of calculating gestational age by determining the first day of the patients last menstrual cycle, counting back three months from that date and then adding one year and seven days to determine the estimated due date. We would measure the fundal height by measuring the distance from the top of the symphysis pubis to the top of the uterine fundus. The distance is centimeters typically matches up with weeks of gestation. We would also assess fetal heart rate by using a hand-held Doppler. A fetal heart beat can typically be heard by using a Doppler between 8-12 weeks gestation. With antepartum care, we would assess the fetal well-being throughout pregnancy by using tools such as assessing fetal movement, ultrasounds and biophysical profiles. Fetal activity provides reassurance of fetal well-being and a decrease in fetal activity could indicate a problem. (Pearson, 2014.) Ultrasounds provide more than just the gender of the fetus they also provide visualizations of the fetal development such as fetal breathing, cardiac structures and if there any fetal anomalies present.
Providing education on maintaining a healthy pregnancy and monitoring the antepartum patient is a key concept is having a safe delivery.
Alexander, Julie (2015) Nursing, A Concept-Bases Approach to Learning. Reproduction. (Chapter 33)
Folic Acid. (2016, December 28). Retrieved May 27, 2017, from https://www.cdc.gov/ncbddd/folicacid/recommendations.html
What can I do to promote a healthy pregnancy? (n.d.). Retrieved May 27, 2017, from https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/pages/healthy-pregnancy.aspx
Paper 2
Pregnant clients and sick clients do have differences in assessments when visiting a clinic. During pregnancy visits many different things will be done, some things are regularly done with every visit and some things are done on specific visits. Prenatal care refers to medical care and other health related services offered during pregnancy to ensure the well being of the mother and her fetus (Kotelchuck, 2002). Antepartum visits follow the pattern recommended by the American College of Obstetricians and Gynecologists. There is an initial visits in the first trimester, one visit every four weeks through twenty eight weeks gestation, a visit every two weeks until thirty six weeks gestation, and then a visit every week through forty weeks gestation. With most pregnancy visits the women will receive a ultrasound to ensure the baby is growing correctly and they will listen to the heart beat. A pregnant women will receive a pelvic exam and Pap smear. The Pap smear will see if there is any abnormal issues with the tissue, and a pelvic exam will be done to check the cervix for any issues that could complicate the pregnancy. A trans-vaginal ultrasound is one of the first ultrasounds that will be done, this is used to detect early pregnancy, observation of fetal heartbeat and fetal moving breathing movements, identification of more than one embryo, clinical estimations of birth weight, detection of fetal abnormalities (Alexander, PG, 2085). During antepartum care a women will be asked a lot of questions that are about past history and current health. Health History is used as a screening tool that identifies factors that may place the mother or fetus at risk during the pregnancy (Alexander, PG. 2050). The categories included in the health history are, Current pregnancy, past pregnancies, gynecological history, current medical history, past medical history, family medical history, religious and spiritual history, occupational history, partners history, and lastly the personal information about the women. The personal information will be consisted of age, race, smoking history, drinking history, medication history, education level, housing situation, and economic level. Some of the tests a women will receive throughout her antepartum visits include, hemoglobin, ABO or RH typing, CBC, RBC, syphilis, an optional DNA test, indirect Coombs test, Group B streptococcus, glucose tolerance, urinalysis, Hep B, HIV, hemoglobin, Pap smear, and gonorrhea. It is important to do this testing because some of these can cause infections that can harm the fetus and cause early birth and possible miscarriages. During sick visits a more focused assessment is going to be done that is directed toward what that persons symptoms are, as with antepartum visits they are looking at a bigger picture. They are looking at the health of the mom and the baby to maintain a healthy pregnancy.
The main focus in a pregnancy visit is to ensure the mom and baby are both healthy. Ensuring the mother and baby are healthy are determined by many different things, ultrasounds, tests, health histories, current health at time of specific visit. Another main focus is to ensure the mother is comfortable and feeling okay. A nurse can provide information that can help the mother with the uncomfortable symptoms that come along with pregnancy. Such as morning sickness, fatigue, and stress. If the mother is feeling stressed throughout her antepartum that can cause stress on the fetus, and this can cause early birth and sometimes miscarriages. It will be important to focus on making sure the mother is eating healthy and exercising regularly, this will help the baby to grow. Eating a well balanced diet is a very important focus, without a healthy diet the baby will not be able to grow or receive the nutrient needed to be healthy. I found an article that discussed the importance of focused assessment in regards to antepartum depression. The article stated that antepartum depression is a significant risk factor for postpartum depression, with a 10 to 12 percent prevalence in all pregnancies (Spinelli, 2003). It is vital that the nurse and or healthcare worker do focused assessments on how the women is feeling, if any signs of depression appear then the nurse will need to assess what is potentially causing the depression. Rates of depression are normally higher for pregnant women with chronic stressors, financial and housing problems and inadequate social support (Spinelli, 2003). If depression is suspected it is important for the nurse to assist the patient in seeking the care needed to help with the depression.
Alexander, J. (2015). Nursing: A Concept-Based Approach to Learning, Volume I (2nd Edition)
Kotelchuck, Milton. \”Prenatal Care.\” Child Development, edited by Neil J. Salkind, Macmillan Reference USA, 2002, pp. 324-328. Gale Virtual Reference Library, go.galegroup.com/ps/i.do?p=GVRL&sw=w&u=lirn42142&v=2.1&id=GALE%7CCX3401000220&it=r&asid=3472d763ddcafb0d3ecd351100ad09e1. Accessed 28 May 2017.
Spinelli, M. G., & Endicott, J. (2003). Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. The American Journal of Psychiatry, 160(3), 555-62. Retrieved from https://search.proquest.com/docview/220482741?accountid=158513
PART 2:
answer this question in min of 250 words with 2 sources:
What is the significance of evaluating or assessing a mother\’s psychosocial with pregnancy or socioeconomic status that goes along with psychosocial. Why would we focus on that?
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