Initial Visit: In a Nutshell (Nursing)

00:00 Now we're ready to review everything we've talked about in this lecture. So, the first thing is that pregnancy signs can be presumptive, probable, or positive. Remember that auscultating fetal heart tones, seeing the fetus actually on ultrasound or fetal movement that the provider perceives, those are going to be positive signs. Everything else indicates there's a possibility that the patient might not be pregnant and has something else going on.

00:27 Naegele's rule is a way that we can calculate due date by using someone's last menstrual period. We subtract 3 months from the last menstrual period, add 7 days, and then 1 year as long as it's not January, February, or March. Gravidity refers to the number of pregnancies.

00:46 Parity is the number of deliveries after 20 weeks. When we think about timeframes of the trimesters, the first trimester is from 0-12 weeks, the second trimester is from 13-28 weeks, and the third trimester is greater than 28 weeks. Quickening is defined by the first perception of fetal movement by the patient. Usually this happens around 18-22 weeks. After 20 weeks, we can measure from the symphysis pubis to the fundus in centimeters and that will match the weeks in gestation within 2 weeks. A CVS is an ultrasound-guided diagnostic fetal test looking for genetic abnormalities performed around 10-13 weeks. An amniocentesis is another test performed after 15 weeks, and it's also diagnostic. The normal fetal heart rate is between 110 beats per minute and 160 beats per minute and can be heard via a Doppler for the first time after 10 weeks. Patients should consume about 400 mcg of folic acid everyday before pregnancy or during the preconception period and 600 mcg during pregnancy. Patients should also engage in about 150 minutes per week of moderate exercise. Patients with a normal or healthy pre-pregnancy weight should expect to gain about 25-35 pounds during pregnancy. Antepartum visit should be every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, and then once a week until delivery. Patients who are Rh negative with a partner who is Rh positive should always receive Rhogam at 28 weeks. They should also receive Rhogam 72 hours after delivery after the blood type of the baby has been confirmed. And don't forget that if there's any bleeding or any procedures that are invasive that are performed during the first or second trimester, they'll also need Rhogam then. That's it.