First Prenatal Visits (Nursing)

00:00 So let's think about timing of the visits because it does change as a client progresses through pregnancy. So the first visit, we like to try to schedule sometime during that first trimester.

00:12 This gives us really effective baseline data of dating the pregnancy and making sure if there are any medical conditions that we know about them early enough that we can stabilize the patient and hopefully have good outcomes. So, some time in that first trimester is when we would like the patient to come in. Now all the way up to 28 weeks, having the client come in about every 4 weeks is what's recommended by the American College of Obstetrics and Gynecology. The recommended time for patients to come in between 28 and 36 weeks is every 2 weeks. And then after 36 weeks, the patient should schedule to come in every week until they deliver. So let's go back through that one more time. The first visit needs to be before the patient reaches the end of the first trimester, so before 12 weeks we want to have at least 1 visit. So from 0 weeks all the way up to 28 weeks, every 4 weeks; from 28 weeks to 36 weeks, every 2 weeks; and after 36 weeks the client should come once a week. So what do we assess on those return visits? We had a lot to do on that initial visit. Every visit is not that way. Typically a return visit is about 15-30 minutes, so we don't do all of those assessments but there are some that we do pretty routinely. One is we check for urine. In this case, we're looking for signs of infection but we're also looking for protein in the urine which may be an indication of preeclampsia. We're also going to take blood pressure because preeclampsia can also show up in the blood pressure. So if we notice that a patient all of a sudden becomes hypertensive and they have a blood pressure greater than 140/90, then that's an indication a complication could be developing. We're also going to check weight really for several reasons. The main reason is that it's a good indicator of how healthy the patient might be and how well the fetus might be growing. If the patient is not gaining weight and that's the expectation during that pregnancy, then that's a sign. And on the other side, if the patient is gaining too much weight then it may be an indication that the patient may have gestational diabetes or they may be retaining fluid which would indicate a complication.

02:19 After 10 weeks, we actually can listen to the fetal heart tones so we can hear it. Do you remember our positive pregnancy signs that a positive auscultation of fetal heart rate would let us know that someone's pregnant. So after 10 weeks, we actually can use a Doppler and listen to the heart tones and hear them. We can measure the fundal height and we can determine whether the baby is growing the way that it should be. That's called McDonald's measurement. We're also going to provide education. So anticipatory guidance. What's going to happen next? What kind of discomforts might expect? When do I know I'm ready to go to the hospital? What should I do about feeding my baby? Those are going to be things that we're going to talk about during the visits during the pregnancy. And then helping the client anticipate any problems. So we don't want to not tell them about round ligament pain for example which we'll talk about in pregnancy discomforts, because that can be scary. We want to let them know what's happening so they'll feel prepared and excited and ready for this pregnancy. For the return visit, there is still some more labs, not nearly as many as in that first initial visit, but we still have some work to do. So let's talk about those. So 2 tests that are performed around 24-28 weeks are the CBC so we can check on oxygenation and any signs of infection and the glucose testing. So this is the first time we can check for gestational diabetes around this timeframe so we'll do that. Around 35 weeks, we can do a swab of the vagina and the rectum called the group beta strep test. Group beta strep is a bacteria that has been linked with preterm labor and sepsis in the newborn. So we want to swab for that around 35 weeks because if the patient is positive for group beta strep, we're actually going to provide prophylaxis in labor to help decrease the amount of group beta strep present and hopefully decrease any of those complications.