Initial Assessment and Labs (Nursing)

00:00 So, what do we assess during our initial visit? What are we doing? What's important for us to understand and collect information about? Well, things like quickening. Has it been experienced or not? Do you remember that quickening means the first perception of fetal movement. We want to know what the symptoms are that the patient might have experienced. We want to know what other symptoms they have had. So we have another lecture where we break down pregnancy discomfort so take a look at that because sometimes the timing of those symptoms that they are experiencing might tell us something about where they are in their pregnancy and it may indicate a complication. We may do a McDonald measurement and I know I keep bringing this up and I promise we're going to go through exactly how we do that in just a minute. I'm going to add another term, lightning. So like thunder and lightning, lightning is a pretty big event and it refers to when the baby drops down into the pelvis. So if you've ever heard someone say "Has your baby dropped yet?" What they are referring to is lightning. Alright? And then we're also going to do general assessments on blood pressure and weight and urine to make sure that everything else is is okay. So this is sort of a general list of the things that we may assess. We talked about some of the assessments that are performed during that antepartum visit, let's now talk about some of the labs and we mean both blood work and cultures. Starting with blood type.

01:25 We need to know if the pregnant client is type A, B, O, whether their Rhesus is positive or negative because this has implications with the fetus. So there may be some incompatibilities that can cause significant complications. We want to know if the patient has a normal hemoglobin or hematocrit, whether they're able to transport oxygen well, whether there is an infection so we can get that from the white blood cell count or platelet count. These are things that we need to know. Antibody screen is also going to be important and we mean other antibodies aside from blood type antibodies. So, certain antibodies can actually cross over the placenta and attack the fetus. So we want to identify those. If we have a patient that identifies as black or Latinx or Asian. There may be some different types of blood dyscrasias or blood disorders that we want to be able to identify and a hemoglobin electrophoresis is going to be indicated. We're also going to check for sexually transmitted infections or diseases. So, HIV, hepatitis B, C, Chlamydia, gonorrhea, syphilis to make sure that the patient does not spread that infection to the fetus. We'll also look for signs of previous infection including rubella and varicella because exposure during pregnancy can also set the fetus up for congenital anomalies. So what we're hoping to find with rubella and varicella is that the client is actually immune. So we're looking for positivity because that implies that they cannot contract rubella or varicella during pregnancy. We'll also get a urine culture because we're looking for signs of infection. Infection can lead to preterm labor, so that's really important to identify as well as group beta strep and we'll talk more about that in just a minute. If it is time, then we can also get a Pap smear. And if you remember from your discussion of GYN, you know that Pap smears look for signs of cervical cancer. Now this is not a priority lab if it's not time for the patient to have that or if the patient has had a history of a previous lost we may not do a Pap smear on an initial visit because the cervix is very sensitive and bleeds very easily.