11.1 First Prenatal Visit
The initial prenatal visit includes a comprehensive history and physical of the person who is pregnant. The history focuses on the pregnant person, the biological father (or sperm donor) of the baby, family, and lifestyle practices. The intake provides subjective data related to the pregnancy, starting with events after the LMP. The physical examination is a modified head-to-toe examination and a focused reproductive examination of the patient. The specimens and blood for laboratory tests are obtained and assist in screening for preexisting and current conditions placing the pregnancy at risk. Prenatal education at the first prenatal visit includes nutrition, avoiding teratogens, adaptation to pregnancy, fetal growth and development, and warning signs to report to the health-care provider. The first prenatal visit sets the foundation for future prenatal care.
11.2 Care in the First Trimester of Pregnancy
Prenatal care in the first trimester of pregnancy often involves reassuring the pregnant person. Auscultation of the fetal heart rate using the Doppler monitor indicates fetal viability, and negative laboratory tests indicate the absence of some risk factors. The monthly visits monitor the adaptation of the pregnant person to the pregnancy and provide opportunities to reinforce education topics, such as nutrition and teratogens. Prenatal care starting in the first trimester has a positive influence on pregnancy outcomes for both the pregnant person and newborn.
11.3 Care in the Second Trimester of Pregnancy
Prenatal care in the second trimester of pregnancy is anything but routine. The subjective and objective data obtained at the monthly visits document the growth and development of the fetus and monitor the adaptation of the pregnant person to the pregnancy. Laboratory tests performed in the second trimester screen for fetal abnormalities, gestational diabetes, and anemia. Ultrasound during the second trimester can reveal abnormalities as well as the sex of the baby. Education topics include recognition of fetal movement patterns and signs and symptoms of complications specific to pregnancy.
11.4 Care in the Third Trimester of Pregnancy
Prenatal care in the third trimester of pregnancy is similar to care in the first two trimesters. The prenatal visits involve obtaining subjective and objective data related to the growth of the fetus, preparing the patient for labor and birth, and monitoring for complications. Laboratory and diagnostic tests are performed routinely and on an as-needed basis. Education topics include recognition of signs of possible complications specific to pregnancy, the process of labor and birth, and preparation for the newborn. The nurse plays a vital role throughout the pregnancy as a provider of prenatal care.
11.5 Family Assessment and Nursing Interventions
The family provides physical and emotional support to assist the pregnant person to maintain their health and the health of the fetus throughout the pregnancy. Assessment of the pregnant person’s family provides data on the roles, functions, characteristics, and expectations of those residing within or outside the household. The analysis of the assessment data is the foundation for identifying current or possible problems and developing a plan of care. For example, if a pregnant person is not gaining weight or becomes anemic, the assessment indicates the household member who purchases the foodstuffs and who cooks the meals. The nurse would plan and implement nutritional interventions that include the household member responsible for buying groceries and cooking meals as well as the pregnant person. When the family assessment reveals the biological father of the baby is not a physical member of the household, there may be more emotional stress on the pregnant person. Without the family assessment, the outcome of the pregnancy for both the pregnant person and the newborn can be negatively affected.