As the nurse, you know that assessment and teaching are vital in the prenatal period to

Question

ensure a positive outcome. What information is important to include at every visit and at
specific times during the pregnancy?

What will be an ideal response?

Answer 1

• Regular prenatal visits are scheduled every 4 weeks until 28 weeks of gestation, every 2 weeks
from 30 to 36 weeks, and every week from 37 weeks to delivery.
• Fetal heart rate (FHR) should be monitored at every visit as soon as it becomes audible, usually at
10 to 12 weeks.
• Fundal height is measured to estimate fetal growth.
• Weight: Desirable weight gain varies among women. Weight gain should be individualized and
monitored according to whether the woman is underweight or overweight. If P.M.'s weight is
within a normal range, she should gain 3 to 5 pounds during the first trimester, and 1 pound per
week thereafter. Be alert for inadequate gain or excessive gain (4 or more pounds), which is often
the first sign of pregnancy-induced hypertension. To maintain a healthy pattern of weight gain,
P.M. needs an extra 340 kcal/day in her second trimester and 460 kcal/day in her third trimester.
This is not the time to diet or "eat for two."
• VS: A rising BP may indicate pregnancy-induced hypertension.
• Deep tendon reflexes: Hyperreflexia may indicate preeclampsia.
• Assess for edema in face, hands, legs, and feet. Edema is common in pregnancy-induced
hypertension. Some edema in feet and ankles is normal in the last trimester.
• Check urine for glucose and protein.
• A glucose test is done at 24 to 28 weeks to check for gestational diabetes mellitus (GDM).
• Address any discomforts the patient might have. These are usually trimester specific and occur as
hormones fluctuate.
• Review the danger signs of pregnancy at each visit and ask whether she has experienced any of
them.
• Self-care monitoring of daily fetal activity and movement after 27 weeks: She is instructed to call
immediately if fetal activity decreases or ceases for 8 to 12 hours. (The time frame might vary;
check with the specific primary care provider [PCP] for office protocol.)
• Stress the need to take prenatal vitamin and mineral supplements to provide folic acid and B6
to
decrease the risk of neural tube defects, iron deficiency, low infant birth weight, and premature
delivery.
• Food safety issues as described in Question 10.
• Stress need for adequate fluid intake: at least 8 glasses (2 L) daily.