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NURS 3381 OB ATI Study Guide
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NURS 3381 OB ATI Study Guide NURS 3381 OB ATI Study Guide NURS 3381 OB ATI Study Guide NURS 3381 OB ATI Study Guide NURS 3381 OB ATI Study Guide NURS 3381 OB ATI Study Guide
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lOMoARcPSD|206264681
OB ATI Study Guide
Initial Prenatal Visit: ↑
Estimated date of delivery based on LMP. Vaginal ultrasound may be done to establish DOD
-
Medical & nursing hx including past med health, family hx, social supports, social hx, & review of
systems (to determine risk factors) & past OB hx
Physical assessment: baseline weight, vitals, pelvic exam
Initial lab work:
o Blood type o Urinalysis
o RH factor o Pap
o HIV status o Indirect Coomb’s test will
o Hep B determine if client is sensitized
o VDRL to RH+ blood
o Rubella status
Ongoing Prenatal Visits:
Monitor weight, BP, & urine for glucose, protein, & leukocytes
Present of edema
Fetal development:
o FHR heard by Doppler at 10-12 wks
o Heard with ultrasound stethoscope at 16-20 wks. Listen at the midline, right above the
symphysis pubis, holding stethoscope firmly on abd
o Measure fundal height after 12 wks. Between 18 & 30 weeks, fundal height measured in
cm should equal the week of gestation. Have pt empty bladder & measure from the
level of the symphysis pubis to the upper border of the fundus
o Begin assessing for fetal movement between 16 & 20 weeks gestation
Routine Lab Tests in Prenatal Care & Their Purpose
Blood type, Rh factor, presence of irregular Determines risk for maternal-fetal blood
antibodies incompatibility (erythroblastosis fetalis) or neonatal
hyperbilirubinemia.
For clients are are Rh(-) & not sensitized, the indirect
Coombs’ test will be repeated b/t 24-28 weeks
gestation
CBC w/ differential, Hgb, Hct Detects infection & anemia
Hgb electrophoresis Identifies hemoglobinopathies (sickle cell anemia &
thalassemia)
Urinalysis: pH, gravity, color, sediment, protein, Identifies DM, gestational HTN, renal disease, &
glucose, albumin, RBCs, WBCs, casts, acetone, & infection
HCG
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1 hr Glucose Tolerance Identifies hyperglycemia; done at initial visit for at-
(oral/IV admin of concentrated glucose w/ venous risk clients, & at 24-28 wks for all pregnant women
sample taken 1 hr later. Fasting not necessary) (>140 requires follow up)
3 hr Glucose Tolerance Used in clients w/ elevated 1-hr glucose tst as a
(fasting overnight prior to oral or IV admin of screening tool for DM.
concentrated glucose with a venous sample taken A dx of GD requires 2 elevated blood-glucose
at 1, 2, & 3 hrs later) readings
Pap Test Screens for cervical cancer, HSV II, &/or HPV
Vaginal/Cervical Culture Detects streptococcus B-hemolytic, Group B
(routinely done at 35-37 wks), BV, STDS (gonorrhea,
chlamydia)
Rubella Titer Determines immunity to rubella.
If non-immune, give shot!
I
PPD, chest screening after 20 weeks w/ + purified Identifies exposure to TB
protein derivative
Hep B Screen Identifies carriers of hep B
VDRL Syphilis screening mandated by law
HIV Detects HIV infection: recommended for all clients
who are pregnant unless client refuses testing
TORCH (Toxoplasmosis, other infections, rubella, Screening for group of infections capable of crossing
cytomegalovirus, & herpes) when indicated the placenta & adversely affecting fetal
development
Maternal serum alpha-fetoprotein (MSAFP) Between 15-22 wks
toxoplasmosis
Other infections
Rubella
Rhogam Administration:
Cytomegalovirus
Herpes
IM around 28 weeks for clients who are Rh (-)
For amniocentesis, car wreck, or any instance of possibility of fetal/maternal blood mixture
Health Promotion:
Avoid all OTC meds, supplements, & rx meds unless OB who is supervising care has knowledge
3-
of this practice
Alcohol (birth defects) & tobacco (low birth weight) contraindicated during pregnancy
Substance abuse of any kind is to be avoid during pregnancy & lactation
Encourage flu vaccine during the fall months
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3
Treat current infections
Ascertain maternal exposure to hazardous materials
Avoid use of hot tubs/saunas
Consume at least 2-3 L of h20 daily from food & beverage sources
Exercise: =
moderate exercise (walking/swimming) consisting of 30 minutes; no new exercise
- -
during pregnancy
Third Trimester Childbirth Prep:
Breathing & relaxation techniques
o Deep cleansing breaths at ½ the usual respiratory rate during ctxns can promote
relaxation of the abd muscles, which lessens the discomfort of uterine ctxns.
discussion regarding pain management during labor & birth (natural child birth, epidural)
Fetal movement/kick counts to ascertain fetal well-being. Client should be instructed to count &
record fetal movements or kicks daily
o It is recommended that mothers count fetal activity 2-3 x/day for 60 mins each time
o Fetal movements <3/hr or movements that cease entirely for 12 hours need further eval
Common Discomforts During Pregnancy:
Morning sickness: eat cracker or dry toast ½ to 1 hr before rising in the morning to prevent
discomfort. Avoid an empty stomach & drink fluids between meals.
UTIs are common due to renal changes & vaginal flora becoming more alkaline
o Wipe front to back, avoid bubble baths, wear cotton panties, avoid tight-fitting pants, &
consume 8 glasses of water/day
o Urinate as soon as urge occurs
Constipation may occur during 2nd & 3rd trimesters. Drink plenty of fluids, eat a diet high in fiber,
exercise regularly
Leg cramps may occur during 3rd trimester d/c compression of lower extremity nerves & blood
vessels by the enlarging uterus
o Homan’s sign should be checked
o If negative, patient should extend the affected leg, keeping knee straight & dorsiflexing
the foot (toes toward the head)
o Massaging & applying heat over affected muscle or a foot massage while the leg is
extended can help relieve cramping
o Notify PCP if frequent cramping occurs
Varicose veins & extremity edema during 2nd & 3rd trimesters
o Rest w/ legs elevated o Avoid sitting w/ legs crossed at
o Avoid constricting clothing knees
o Wear support hose o Sleep in left lateral position
o Avoid sitting or standing in one
position for long periods of
time
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