Untitled

• This lecture will cover the care of mothers and children deemed at-risk
• This can include risk of problems

Maternal and Child Care Nursing

Course description

• This course addresses disturbances and pre-existing health issues in pregnant women and pathological changes during intrapartum and postpartum

Course objectivies

Upon completion, students can:

• Use the nursing process for holistic client care in community and hospital
• Assess client health and risk factors
• Identify actual and potential nursing diagnoses
• Plan appropriate client interventions
• Implement appropriate client interventions
• Evaluate client progress and outcomes

5 Branches of Maternal Health

• Nutrition: Baby's development relies on adequate nutrition for mother
• Prenatal Care: Maintain delivery safety and manage potential birth defects
• Safe Delivery
• Breastfeeding: Optional, depends on the understanding, perspective and desire of the mother
• Family Planning: Average, 2-3 years between pregnancies

Breastfeeding mnemonics

• Breastfeeding, B-R-E-A-S-T F-E-E-D-I-N-G, is:
• Best for baby and mommy, reduces allergies, economical (no waste), antibodies to protect baby from infection, sterile and pure
• Temperature always ideal, fresh milk (never goes off), easy to prepare and digest, eradicates feeding difficulties
• Develops mother and child bonding, immediately available, nutritionally optimal; gastro-enteritis greatly reduced

Prenatal care

• The goal of prenatal care is to ensure uncomplicated pregnancy, the delivery of a live, healthy baby
• Issues may arise before conception if the potential mother has pre-existing health conditions

Regular vs Early prenatal care

• Regular prenatal care improves healthy outcomes; check-ups should be completed
• Early congenital/birth defect detection through ultrasound as early as 8 weeks, 20 weeks, and 38-36 weeks
• Early detection checks baby movement, breech position if relevant, and all development
• Prenatal immunization prevents mother-to-child transmission
• Anti-tetanus vaccine and vitamin A administration
  • Tetanus Toxoid: 5 lifetime doses, circulating to baby

DOH Standards For Prenatal care

• Addresses key components for thorough maternal assessment

Weight

• 5-pound weekly increase is expected to balance fetal and fluid weight gains

Height

Blood Pressure

• Methyldopa is the preferred medication if blood pressure elevated

Fetal Heart Tones (FHT)

• Evaluated to verify the baby's well-being and movement
• Typically audible at 5 months/20 weeks into pregnancy

Fundic Height

• Symphysis pubis to the fundus
• 5th month: 20 cm
• 6th month: 21-24 cm
• 7th month: 25-28 cm
• 8th month: 29-30 cm
• 9th month: 30-34 cm

Leopold's Maneuver

• Non-invasive fetal assessment (presentation, position, attitude)
• Fundal grip (presentation), umbilical grip (position), Pawlick’s grip (engagement), and pelvic grip (attitude)

TT Immunization

• Tetanus Toxoid schedule depends on prior vaccination status:
  • TT1: Anytime during pregnancy
  • TT2: 4 weeks after TT1
  • TT3: 6 months after TT2
  • TT4: 1 year after TT3
  • TT5: 1 year after TT4

Diet

• Adequate calories, low carbs, more protein

Danger sign assessment

• Elevated blood sugar, unusual bleeding, premature uterine contraction, hypertension, PROM, dizziness, headache

Breastfeeding

• Early initiation

Family Planning

Postpartum Care

High Risk Pregnancy

• Due to multiple factors increasing poor maternal/fetal outcomes
• Can be medical, reproductive, psychosocial, and/or obstetrical causes

Diagnostic and Laboratory assessment

• Done for management with any abnormal result

Complete Blood Count

• Hemoglobin: 120-160 (female: 12-16; male: 12-18)
• Hematocrit: 36-48%
• Leukocyte: 4-11
• Thrombocytes: 350,000-450,000
• Blood Typing: a, b, ab, o
• Rhesus Factor: Rh (+) or (-)
• Erythrocytes/RBC: 4.5-6

Low Hematocrit causes

• Sickle cell anemia (crescent-shaped RBCs, inadequate oxygen transport)
• Leukemia (low WBC)
• Hemolytic anemia (ruptured RBCs)
• Iron/Folate/Vitamin B12 Deficiency (reduced RBC production)
• Bone marrow disease (impaired cell production)
• Chronic inflammatory disease (capillary dilation/rupture)
• Kidney failure (no erythropoietin, thus impaired RBC production)

Lymphoma

• Lymph vessel cancer (trapped fluid and blood)

High Hematocrit causes

• Polycythemia Vera (increased cells/blood)
• Kidney tumor (edema = more fluids + plasma)
• Congenital heart disease (left-to-right shunting)
• Dehydration (less water = hemoconcentration)
• Excessive diarrhea may make hematocrit high due to plasma loss
• Lung disease (pneumonia)

Urinalysis

• Assesses various factors in urine.
• Pus cells, bacteria, protein/albumin, and sugar
• Protein/albumin (PIH if +; +1 to +4 severity), sugar (GDM if +; (-) glucose = no GDM, (+) glucose = GDM)
• Squamous epithelial cells (normal)

Pap Smear

• Checks cervical secretion to get samples for biospy for cervical cancer
• Checks cervical secretion to get samples for STI
• Checks cervical secretion to check for RBOW or LBOW

Ultrasound

• Sonography determines baby status, amniotic fluid conditions, fetal anatomy, fetal heart measurements and placental placement
• Transabdominal: over the fundus
• Transvaginal: probe insertion into the vagina

Amniocentesis

• Aspiration of amniotic fluid
• Detects congenital anomalies, trisomy issues, and fetal defects.

Chorionic Villi Sampling

• Check for possible problem or defect inside of the probe

Maternal Alpha-Feto Protein

• Checks AFP level to detect neural tube defects (ex. spina bifada.)
• AFP (substance made in liver of fetus)
  • Spina bifida is a neural tube dosorder
• Anencephaly if there is no skull
• Gastroschisis if intestines are outside the body = straight to NICU for surgery soon

Doppler Velocimetry

• Assesses of umbilical cord and placenta blood flow between the uterus and baby
• To see the contractions if the waves are strong while the baby is inside the mother's womb.

Percutaneous Umbilical Blood sampling

• Determines the position of the fetus + umbilical cord on a monitor.

Biophysical scoring assesses baby health

• 30 minutes of UZD observation with the following results
  • 8-18 normal fetus
  • 6 = chronic asphyxia which means repeat procedure after 24hrs
  • 4 = abnormal result
  • 2 = termination of pregnancy
• 5 markers
  • Determines the response of the fetal HR vs Fetal movement at certain time
  • Results in a grading scale from 0-2
  • 2 = 2 or more FHT acclerations per moment
  • 1 = <2 acclerations per movement
  • 0 = no acceleration

Fetal Breathing

• 2 episode/30 mins lasting 30 secs
• 0 - no episode

Amniotic Fluid Index

• Normal AFI - 5-15 cm water (some books up to 20cm) -Results given
  • 2- fluid filled pocket of 1 cm or more
  • 0- no amniotic fluid or less than 1 cm in every pocket
  • Polyhydramnios- too much production of Amniotic fluid: intervention (less fluid intake)
  • Oligohydramnios - less production: intervention ( more fluid intake)

Fetal Body Movement

• Assess if these there more moments and the way the movement feels:
  • 3 or more discrete movement of limbs and body in 30 mins
  • 1- less than 3 moments
  • 0 - no movements

Fetal Hearth Tone

• 2-1 or more episodes of active extension with return to felxion of limbs and trunk
  • 1 - slow extension with return
  • -0 flexion

Hepatitis B Detemination

• SOP - protection against infection to get accurate result

Hepatitis B antigen

• reactive = is positive (isolate patient + nurses should double glove_
• Non-reactive = negative (patient should stay in the labor room)
  • test that look for the antibodies that your immune system are making + will use the surface protein of the virus B)
    • Qualitative vs Quantitave are the various reasons for that

Contraction stress test (CST)

• done after 32 weeks AOG Determine if the baby can tolerate contractions and use electronic fetal monitoring to see if the baby can tolerare the contractions Negative = normal, no fetal heart deceleration Positive = abnormal, with deceleration

Fetoscopy

• Direct visualization of the fetus through a scope . Is an endoscoopuc prceodure during pregnancy to allow. access to the fetus, the amniotic cavity, the umbilical. cord, and the fetal side of the placenta

May use to

• Obtain sampe tissues or blood. May perform intrauterine fetal surgery

Fetal Movement counting

Done after 27 weeks AOG + proof baby alive

• Twice daily for 20-30 minutes with the number of movemnts
  • Normal - 5-6 movements in 20-30 minutes
  • Abnormal - less done 3 movements in 1 hour

Cardiovascular disorders +

The blood increase is from about 49% - 50% increase on the blood to prepare and have reserves to prevent blood lose to accomodate increase cardiac output

Increase 15% size of Ventricular hamber

Pregnancy

• Increase Cardiac output - 40-50 %
• 5-6L of blood is ejected per minute
• 7.5L/min normal of pregnant
• Decrease BP during 1st trimester
• Increased size of Ventricular chamber

Ventricular Septal Defect - VSD

• left ventricular hypertrophy + pulmonary hypertension + Right ventricular hypertrophy
• MV
• AV
• Vagal
• Pulmonary Veing
• MV
• Left of the aorta IVC

LEFT TO RIGHT Shunting

• Devation betwwen the left and right side of the heart
• compromised with oxegtntation because of mix oxygenated ad d oxygented

Atrial Septal Defect ASD-

• asymptomatic. * incresed with flow *hypertenion+ Similar group A. beta Hemo Group+ infart Process Auto-immune disease + + +scars

Function Classifications Of Cardiac diseases

• CLASS I Asymptomatic
• CLASS II symptomatic but without normal activities
• CLASS III sympathetic with less and normal activities
• CLASS IV Synthesizing

Judagment Safety pregnancy

• Conception ovulation to implantation
• conception is should perventife if;

1. Sereve heart Disease
2. Functional Classification ; Class III - IV History of Heart Failure. Functional class

• can leads to Fetal distress Rehumatic Fever & combined Valued Discases

Managment Of Diaseses

• Check up with regular checkup.
• prevent Infection+
• monitor 1 and 0 +

Medical Compications During Pregancy

• Gestational diabetes MELLITUS

GDM Pathophysiology

• HPL = increase ATP in cells = mascrosonia

increase glucose present in the blood excessive with comes placenta to reach cycle

Gesttational Risk factors for getting GDM

• obseity More thean 33
• *Overweight 25 kgs

Diagnostic TEST

DURING pregnact weight 20-25 kgs+ History Sedentry live style

• HCI (1.80)
• ** OG TT
• PST - Prandial +++ELECTRO

DOH STANDARDS FOR PRENATAL CARE

weight +high weight + weight gain of + fetus and *Fluic

• Weight gain of plus size is equal to the expected weight gain of a pre pregnant woman.

•Kidney and failure = epoeitin = not stimulation

• Cancer- fluid and blood

HELLP syndrome occurs during

• *Liver and blood +1 25-35

• Low carb cal

==End of questions and notes==