Para or Gravida

I don't know much about L&D so I don't know how "normal" a murmur is post pregnancy. I have 3 catagories of notifiying the MD:

1) Important enought to call in the middle of the night about (I work nights).

2) Important but either I call about it before 10pm or wait until 6am to call about it.

3) I want the MD to know but can wait until I see him/her to to tell them.

I would say that a patient having a murmur post birth is a significant enough change that it would fit in the 2nd calling catagory. Hopefully you'll see the doctor and just be able to bring it to their attention while they are there, but if not I would call and notify within reasonable calling hours. Remember, you have to CYA (Cover your a**) and while a change may not be unexpected changes it things like heart function, renal function, and respiratory issues are most of the times things you should call about. I have been a nurse for 1 year and can tell you that there have been several things I've thought were not worth mentioning or could wait until the MD came to the floor and the doctor ended up being ****** because I didn't call as soon as the change occured. I can also say there have been several times I've called with a change I thought was important and the doctor was ******/didn't give a hoot about the call. It is a catch-22 / no win situation. You just kinda have to learn what each doctor prefers as time goes by and when you are questioning if you should call or not you should call. While you should always be vigilant about if your patient is truly in trouble or not, calling the MD is not only for urgent changes. Calling the MD can be about keeping the MD apprised of patient changes so that they can decide if something needs to be done or not. Let the doctor be in control and document every change in your patient ALWAYS (even benign changes) and if you call the doctor ALWAYS put in your notes that you notified the MD even if they wrote new orders or not.

Oops...sorry for that little detail. the murmur was at the beginning of the 3rd Trimester.

The gravida/para concept was explained nicely. Let's talk about this "murmur." First, if the murmur was noted at the beginning of the third trimester, was it not documented and noted at that time? A systolic ejection/flow murmur in late pregnancy is a common finding. Some sources say 90% or more of all pregnant patients. If you review your anatomy and physiology, this should come as no surprise. Just consider the fluid and volume changes that occur and how they relate to cardiac physiology. You have allot of extra fluid volume that the heart is forced to pump.

Additionally, many other cardiovascular changes such as increased cardiac output and shifting of the PMI are also commonly noted during pregnancy.

So, if this is an already known and documented condition, you may want to reconsider calling the doctor. However, acute changes or deviations from the known baseline are cause for concern.

Technically...

When she becomes pregnant the first time she is a primigravida.

When she becomes pregnant the second time she is a secundigravida. (a very rarely used term...most people talk about parity, not gravidity)

When she becomes pregnant the third time she is a multigravida.

Para is the part that people tend to mess up all of the time...

Your patient is still a primipara until she delivers the second baby after 20 weeks. She enters labor a G2 P1 and leaves a G2 P2 (no matter how many babies she delivered from that pregnancy. Triplets and she's still P2). If you're using TPAL (term, premature, abortion, living), she'd be G2 T2 P0 A0 L2 after delivery (unless she had triplets when she'd be T2 P0 A0 L4, assuming she carried the triplets to term).

Did I just make this more complicated? Didn't mean to.

Your patient is still a primipara until she delivers the second baby after 20 weeks. She enters labor a G2 P1 and leaves a G2 P2 (no matter how many babies she delivered from that pregnancy. Triplets and she's still P2). If you're using TPAL (term, premature, abortion, living), she'd be G2 T2 P0 A0 L2 after delivery (unless she had triplets when she'd be T2 P0 A0 L4, assuming she carried the triplets to term).

Did I just make this more complicated? Didn't mean to.

This is partially correct. If she carries triplets, after delivery she is a G2 P2 using the G/P system. But if you're using G/TPAL or G/TPALM (which everyone involved in obstetrics probably should be using), then she is a G2 P40041 (assuming they were all delivered at term). The TPAL or TPALM method counts # of babies instead of # of pregnancies.

Reference: Varney's Midwifery (2004).

Do you/Where do you count miscarriages and stillbirths in these systems?

Do you/Where do you count miscarriages and stillbirths in these systems?

Not an OB nurse, but miscarriages are counted under abortions. A miscarriage is considered a spontaneous abortion.

Yeah I was wondering about that...I knew miscarriages were spontaneous abortions...but medically isn't an abortion different than a spontaneous abortion? Your body naturally having an abortion versus an induced abortion..hmm. But than what about stillbirth. My guess would be it counts as a pregnancy but is omitted in living children...? But does it count in the term or preterm category?

Not an OB nurse, but miscarriages are counted under abortions. A miscarriage is considered a spontaneous abortion.

Yep...

T=term (37+ weeks)

P=preterm (less than 37 weeks)

A=abortions (spontaneous & therapeutic)

L=living children

M=multiple pregnancies