4. Assessment: initial physical aspects:
1. Height and weight.
2. Vital signs.
3. Blood work - hematocrit and hemoglobin for anemia; type and Rh factor; tests for sickle cell trait, syphilis, rubella antibody titer, and hepatitis B screen.
4. Urinalysis - glucose, protein, ketones, signs of infection, and pregnancy test (HCG).
5. Breast examination.
6. Pelvic examination.
1. Signs of pregnancy.
2. Adequacy of pelvis and pelvic structures.
3. Size and position of uterus.
4. Papanicolau smear.
5. Smears for mondial and trichomona! infections.
6. Signs of pelvic inflammatory disease.
7. Tests for STD: Gonorrhea (Gonococcus-GC), chlamydia.
7. Validation of pregnancy - physician or midwife makes differential diagnosis between presumptive/probable signs/symptoms of early pregnancy and other signs.
1. Presumptive symptoms - subjective experiences.
1. Amenorrhea - more than 10 days past missed menstrual period.
2. Breast tenderness, enlargement.
3. Nausea and vomiting.
4. Quickening (wk 16-18).
5. Urinary frequency.
6. Fatigue.
7. Constipation (50% of women).
2. Presumptive signs
1. Striae gravidarum, linea nigra, chloasma (after wk 16).
2. Increased basal body temperature (BBT)
3. Probable signs - examiner’s objective findings.
1. Positive pregnancy test.
2. Enlargement of abdomen/uterus.
3. Reproductive organ changes (after sixth week):
1. Goodell’s sign - cervical softening.
2. Hegar’s sign - softening of lower uterine segment.
3. Vaginal changes (Chadwick’s sign): purple hue in vulvar/vaginal area.
4. Ballottement (after 16-20 wk).
5. Braxton-Hicks contractions.
4. Positive signs of pregnancy:
1. Fetal heart tones.
1. Doptone: wk 10-12.
2. Fetoscope: wk 20.
2. Examiner visualizes and feels fetal movements (usually after wk 24).
3. Sonographic examination (after wk 14) when fetal head is sufficiently developed for accurate determination of gestational age. Pregnancy may be detected as early as fifth or sixth week after LMP.
5. Assessment: nutritional status:
1. Physical findings suggesting poor nutritional status:
1. Skin: rough, dry, scaly.
2. Lips: lesions in corners.
3. Hair: dull, brittle.
4. Mucous membranes: pale.
5. Dental caries.
2. Height, weight, age - average weight gain approximately 24 lb. Range from 24 to 32 lb is best for mother and neonate.
3. Laboratory values - Hemoglobin: . < 10.5/100 mg. Hct < 32% indicates anemia.
4. Nutrition history.
5. Analysis/nursing diagnosis:
1. Altered nutrition: less than body requirements related to anemia, vitamin/mineral deficit.
2. Altered nutrition: more than body requirements related to obesity.
6. Nursing care plan/implementation:
   Goal: health teaching. Nutritional counseling for diet in pregnancy and/or lactation.
7. Evaluation/outcome criteria:
1. If underweight at conception: should gain 28-42 lb (12.5-18 kg).
2. If overweight at conception: 15-25 lb (7-11.5 kg).
3. If obese at conception: 15 lb (7 kg) or more.
6. Assessment: psychosocial aspects:
1. Pregnancy: planned or not; desired or not.
2. Present plans:
1. Carry pregnancy, keep baby.
2. Carry pregnancy, adoption.
3. Abortion.
3. Cultural, ethnic influences on decisions: will influence range of activities, types of safeguarding actions, diet, and health-promotion behaviors.
4. Parenting potential: actively seeking medical care and information about pregnancy, childbirth, parenthood
5. Family readiness for childbearing and child rearing:
   1. Physical maintenanc
   2. Allocation of resources: identify support system.
   3. Division of labor.
   4. Socialization of family members.
   5. Reproduction, recruitment, launching of family members into society.
   6. Maintenance of order (relationships within family).
6. Perceptions of present and projected family relationships.
7. Review lifestyle for smoking, drugs, alcohol (ETOH), attitudes to pregnancy, health care practices, and risks for hepatitis and human immunodeficiency virus (HIV).
7. Analysis/nursing diagnosis:
   1. Altered role performance related to stress imposed by developmental tasks.
   2. Ineffective coping: individual, family related to stress caused by developmental tasks/crises.
   3. Altered family process related to developmental tasks. First baby may precipitate individual or family developmental crisis.
   
   
8. Nursing care plan/implementation:
   1. Goal: anticipatory guidance/support.
      1. Discuss mood swings, ambivalent feelings, negative feelings.
      2. Reinforce “normalcy” of such feelings.
   2. Goal: increase individual/family coping skills, reduce intrafamily stress.
      1. Reinforce family strengths (both partners), sense of family identity.
         1. Encourage open communication between partners; share feelings and concerns.
         2. Increase understanding of mutual needs, encourage mutuality of support.
         3. Increase tendency of mother to turn to partner as most significant person (as opposed to physician).
         4. Enhance bond, success of childbirth preparation classes.
      2. Promote understanding/acceptance of role chang
         1. Facilitate/support achievement of developmental tasks.
         2. Reduce probability of postpartal psychological problems.
         3. Promote family bondin
   3. Goal: health teaching
      1. Siblings:
         1. Alert parents to sibling needs for security, love
         2. Include sibling in pregnancy experience
         3. Provide clear, simple explanations of happenings.
         4. Continue demonstrations of love
         5. Describe increased status (“big sister/ brother”).
         6. Discuss possible misbehavior to gain attention.
      2. Relatives: alert parents to possible negative feelings of in-laws.
      3. Referral to childbirth preparation/parenting classes.
      4. Appropriate community referrals for financial relief to decrease stress and provide aid.
9. Evaluation/outcome criteria:
   1. Actively participates in pregnancy-related decision making
   2. Expresses satisfaction with decisions mad
   3. Demonstrates growth and development in parenting role
   4. Prepared for the birth and for early parenthood