BG 559007 pig Fey PURPOSES oF Deernine A06 ation PRENATAL onityr an , maternal a ininize risks oF posible Loma F stants baseline Pf ducate et nancy, es newborn - sh ld PRENATAL sp a mde Os Soon as pregnancy - eu ior be det oad visit, more frequent Q 4 whe up t) 28 wks te 4 risk : wis up ty 3b wis wh until bicth » HISTORY TAKING 0) Dem raphe Data- nome, age, Q a ae: rete famil eal (py cg aoe ‘appt person ) b) Pack Medical 3 Surgical He - allergies, immunizahons, $10s, diseasec cing noeed HD, Cheredd familial diseases (9) ovine 2 yatta Ay - Age at menarche, length of cade durahen 2 “chatate tie mencyual flow , digemterk, gynecologic cu eries, LMP,/ / d) Chief Concern - reacen for coming Ww prenatal core especially if wnscveduled vainded? - Is Monty inbended : - napeiut b ifeon diseases? - ingection of unprecoribed medications | drugs ? -N&v? - Donger signs: vaginal bleeding, cweil 1 at 2 fingers, 4 severe headache (cmtinuows), dimness / blurring of visim, Floches of light / dots before eyes, abdominal pain, persictent vomiting , chills 2 fevir. sudden eccage of fluids fiom @ vagina, absence of fetal 1 sands initial aurcultation at dct moth 4 ASSESSMENT EXAM - review of Syctems; ht, wh, prepregnout MI, vis, fwndal i! meacurement (> 12 whs), fetal 9 sound: PELVIC. EXAM : examination of & internal 4 external genitalia, bimanual exam, pelvic shape, pelvic measurements Cardinal tule: EMPTY BWODER Pircr/ / - vaginal speculum i used : Nurcing Actions: Cxplain @ procedure 2 alba en ak quecions and uapress her motions o SD may be allowed at head’ of % Ved! team tole © assist chen’ in & lithotom position e slant clevate head of a explain ig i y nat ic t he arden! @ instvuc client to do feloved breathing EXTERNAL GENITALIA - Note fir Gignt Of inflammation, infection, uleerabons, lion, vaginal discharge, w Grcumcision - heats singh virus ain NN ductered, pinpoin iy) ome, 8 Nid on tn oy patie : vulva; no NSVY, om ivery feongtal in by Cc, prophylactic Meet ment given +) & client of 6 end & pregnancy + prevent neonatal tran'tmiscian (at birth) S——> Skene 3 ortholin glonds - qoute check fr se, nitty, 2 itity discharge — ditchorged ntuoeen ts wwe te eck cause Conjunchvit ing/ / = problem: 7 vaginal muscle wail Support: wombn if osed —"'e veckocele = forward pouchie 9 tor down whi © gt Grew inte § me nin is seporatea potterior vaginal wal "owthing © wstocele - pouching #e 4 indder ints anterior vaginal wall INTERNAL GENITAUA - incpection OF @ cervix ° . centeved + cetroverted uterus artterior © anvtverted uters- posterior - (olor: ; ® nonpregnant - light pink ¢ pregnant ~ purplish ~ cervical of. ©) nulli gravida p childbirth (er) " gtell ote “star-like” ? mild cervical tear MPICAL INFECTIONS - Trichomoniacis: protoroal infxn , fetechial spok on vaginal walls, cervical rednecs, profuse whitish bubbly discharge % frichomoni ais ond Yacterial waginasis muck ye treoted in graen a a tan_cauce preterm birth ~Candidot (Yeast) Tnfgn: ttehing, Gurmng sensation; clumpy cheese - like aha je Meat may Cause bleeding when scraped anny/ / — bonorrhea~ thick, yellou- greenish dischorge and extreme iaflammation — Chlamy din: *silent* invisible” inka, sows almost ao external syngas bub internally causes muco Cervical discharge ond aa Cervical redness cultures should be caused ducing & initial gelvic exam ; iS < 25 y-o., between a : ote Tn @ newhorn’. © Qonorehen causes severe conjunctivitis ch can lead 49 blindness + chlemydin cawses prewneaia or unctivi tis © candidal iAfin cauces thrush or oral candi olid sic PAPANICOLAU SMEAR (PAP SMEAR) ~ cytological examination + de tara covtinom A; int photw - Claccificaton of Find Clag 1+ absence ns abe clk Clace a: abn® cytology but no Cidene & malign Class 9: “yy saga Glass 4: gi ring supp Class M mdton fer malign ancy ~ Clinical stages that reflect loculitation or metatasis Stage (: CA Confined #9 & Cervix Stage 9: extends Veyond @ cervix ind ¢ Vagind ; but wot inte ? pelvic wall or lower Yo/ / of & vagina Stage 3: melt ci i ¢ phic w Stage 4: mebactacic beyond vic pe ¢ bladder and re PELVIC SHAPE © Qyne coid : “female” pelvit ; adequate for childbirth o android: * male” pel vit o dnthropoid: “ape-hke" pelvis o platypelloid: “Flatten ed * pelvis/ / PELVIC MEASUREMENTS ~ reveals @ diametey of & inlet 2 autlet via vimetry during routing senoge i nua medcuremeat ween t anterior swface Sacral promincace, and : puri surtout oF & is; overa ge teoetenet ic (0.5 cm- tem o ischial tuberdcity- gittance between icchial dtbensihes OF 4 Hansvent diameter of & outlet; a diameter of Nom ic one adequate External ischial tuberosity width (EITW)/ / LABORATORY “toyty URINALYSIC — Albuminuria: heat acetic acd feck; ign OF txemia = proteinuria ~ Glycocuria + Benedict's tect; Giga of possible gectahonal diabetes > urine ollected & breakfact 4» avoid falce Ct) recut’; should ve no more than +4 sugar = Pyuria: grecence of Whos in @ rs wide, sign OF infgn Cc (Complete élood _ tount:) - hob (hemoglobin) » t devert : ni Chem afoerit) | onemi - WBC ty determine infin - plotelet comnt f ahmate clotting Spility Blood TMpinb Cé Rh Factor) ~ 4 prepore Wood in case oF bleeding during pregna -t det 2 Pui ty ‘e 160.2 Rh icoimmunization OMERS ; - Tubuila ther, Repth: B Surtore onhgen = t check if ¢ women is bed/ / ~ Venereal dickoge research labsratiry (VDRL) © apid plarma reagin tect (RPR tect) 10 check for syphilis - HIV: ELISA conficmed by Western Blot - Cervical cmeart: gonorrhea, chlamy dia TUBERULOSIS SCREENING - Montoux tect - purified protein derivative (PPD) tet © O.4ml' OF PPD, 10 lintradermal) © 48-72" aren is inspected + results: indwration of ot leact 10cm i considered positive Sum considered abe foe immunocompromi ced or 4 immune responce implications: prcitive reculls indicate tat & petson bas Tho i exposed t9 TO w was given 6C6 Vacune; if a woman is Gi) , a chest Xrty will be ordered NSc AGRON: accure & woman that @ fetuc will be protected during & Xray & © lead npren over her abdomen