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First prenatal visit: why is
she here?
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Collect prepregnant history:
weight; nutrition; Rx, OTC or recreational drugs; allergies; potential
teratogens; surgery or medical hx that could affect pregnancy: viral
infections, diabetes, HTN, renal, thyroid, bleeding disorders; GYN HX, inc.
last pelvic exam, PAP, previous infections; age of menarche, contraceptive
HX, OB HX
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Physical: 1. Fetal heart
tones (FHT; fetoscope at 16 wks, or
ultrasound Doppler beg. 8 wks.) Range: 120 – 160 bpm 2. Fundal height – from
symphysis pubis to top of uterine fundus in centimeters; estimates gestational
age, fetal growth. 3. Complete
physical, including pelvic musculature, size of uterus, & adequacy of
pelvis for delivery
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4. Labs: Hct, Hgb, blood
type , Rh and irregular antibody; rubella titer; TB skin test; renal function
tests, UA with culture; screening for STIs.; Pap test and offer of HIV test
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Psychosocial: assess for
emotions/feelings re: pregnancy; support systems; stability of client’s
immediate and extended family; economic support; cultural preferences;
preference of caregiver
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Follow-up: Q 4 wks during 1st 28 wks; Q 2
wks until 36 wks; then Q wk until delivery
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Quickening (first fetal
movement felt, usually between 16 – 22 wks) & colostrum production (early
in pregnancy); danger signs of pregnancy; blood levels of alpha-fetoprotein
(AFP) for neural tube defects at 16 to 18 weeks; maternal blood glucose level
at 24 – 28 wks to screen for gestational diabetes
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Each visit: measure fundal
height, movement, and fetal heart rate
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