05 FETAL DEVELOPMENT.pdf

CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌ ‌ ADOLESCENT,‌‌AND‌‌FAMILY‌‌ ‌ IDIANALE‌‌BATCH‌‌2024‌ ‌ ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌ ‌ ‌ TOPIC‌‌5:‌‌FETAL‌‌DEVELOPMENT‌ ‌ ‌ ‌ Concep...

CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌ ‌ ADOLESCENT,‌‌AND‌‌FAMILY‌‌ ‌ IDIANALE‌‌BATCH‌‌2024‌ ‌ ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌ ‌ ‌ TOPIC‌‌5:‌‌FETAL‌‌DEVELOPMENT‌ ‌ ‌ ‌ Conceptus‌ ‌–‌ ‌all‌ ‌tissue‌ ‌products‌ ‌of‌‌ ‌ conception,‌‌embryo,‌‌fetal‌‌membranes.‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ PREGNANCY‌‌CALCULATION‌ ‌ Pregnancy‌‌calculated‌‌to‌‌last‌‌an‌‌average‌‌of‌‌ 10‌ ‌ ‌ lunar‌‌months:‌‌40‌‌weeks‌‌or‌‌280‌‌days,‌ ‌ calculated‌‌f rom‌‌onset‌‌of‌‌last‌‌normal‌ ‌ menstrual‌‌period‌‌to‌‌time‌‌of‌‌birth‌ ‌ Human‌‌development‌‌follows‌‌three‌‌stages:‌ ‌ ○ Pre-embryonic‌‌stage‌‌(first‌‌14‌‌days)‌ ‌ ○ Embryonic‌ ‌stage‌ ‌(15th‌ ‌day‌ ‌to‌‌ eighth‌‌week)‌ ‌ ○ Fetal‌ ‌stage‌ ‌(eighth‌ ‌week‌ ‌to‌‌ delivery)‌ ‌ ‌ DEFINITION‌‌OF‌‌TERMS‌ ‌ Zygote‌ ‌–‌ ‌cells‌ ‌result‌ ‌f rom‌ ‌fertilization‌ ‌of‌‌ ‌ ovum‌‌and‌‌sperm.‌ ‌ FETAL‌‌CIRCULATION‌‌ ‌ Blastomere‌ ‌–‌ ‌daughter‌ ‌cell‌ ‌arising‌ ‌f rom‌‌ mitotic‌‌division‌‌of‌‌the‌‌zygote.‌ ‌ Morula‌ ‌–‌ ‌solid‌ ‌ball‌ ‌of‌ ‌cell‌ ‌formed‌ ‌by‌ ‌16‌ ‌or‌‌ more‌‌blastomeres.‌ ‌ Blastocyst‌ ‌–‌ ‌morula‌ ‌with‌ ‌a‌ ‌fluid‌ ‌cavity‌‌ stage‌ ‌of‌ ‌human‌ ‌development‌ ‌within‌ ‌the‌‌ uterine‌‌cavity‌ ‌ Embryo‌‌–‌‌made‌‌of‌‌an‌‌embryo-forming‌‌cell‌‌ group‌‌as‌‌the‌‌inner‌‌cell‌‌mass.‌ Embryonic‌ ‌period‌ ‌–‌ ‌3rd‌ ‌to‌ ‌7th‌ ‌week‌ ‌after‌‌ fertilization.‌ ‌ Fetus‌ ‌–‌ ‌developing‌ ‌conceptus‌ ‌after‌ ‌the‌‌ embryonic‌‌period,‌‌8th‌‌week‌‌to‌‌term.‌ ‌ ‌ ‌ PROPERTY‌‌OF‌‌ODLID‌ ‌ 28‌ ‌ ‌ CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌ ‌ ADOLESCENT,‌‌AND‌‌FAMILY‌‌ ‌ IDIANALE‌‌BATCH‌‌2024‌ ‌ ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌ ‌ ‌ SUBSTANCES‌‌THAT‌‌MOVE‌‌ACROSS‌‌THE‌‌ PLACENTA‌ ‌ 28‌‌weeks‌ ‌ ○ High‌‌rate‌‌of‌‌survival‌ ‌ Simple‌ ‌diffusion‌ ‌including‌ ‌water,‌ ‌oxygen,‌‌ 32‌‌weeks‌‌ ‌ carbon‌ ‌dioxide,electrolytes,‌ ‌anesthetic‌‌ ○ Fetus‌ ‌is‌ ‌aware‌ ‌of‌ ‌sounds‌ ‌outside‌‌ gases,‌‌and‌‌drugs.‌ ‌ the‌‌mother’s‌‌body‌ ‌ Facilitated‌ ‌transport‌ ‌includes‌ ‌glucose,‌‌ 36‌‌weeks‌‌ ‌ galactose,‌‌and‌‌some‌‌oxygen.‌ ‌ ○ Lanugo‌‌disappears‌ ‌ Active‌ ‌transport‌ ‌includes‌ ‌amino‌ ‌acids,‌‌ ○ Lungs‌‌are‌‌well‌‌developed‌ ‌ calcium,‌ ‌iron,‌ ‌iodine,water-soluble‌‌ 40‌‌weeks‌‌ ‌ vitamins,‌‌and‌‌glucose.‌ ‌ ○ Full‌‌term‌‌pregnancy‌ ‌ Functional‌ ‌exchange‌ ‌at‌ ‌the‌ ‌placental‌‌ ○ little‌ ‌lanugo,‌ ‌vernix‌ ‌caseosa‌ ‌still‌‌ membrane‌ ‌can‌ ‌include‌ ‌reduction‌ ‌of‌‌ present‌ ‌ surface‌ ‌area‌ ‌(abruption)‌ ‌and‌ ‌diffusion‌‌ distance(labor,‌‌pre-eclampsia).‌ ‌ ‌ FETAL‌‌DEVELOPMENT‌ ‌ First‌‌Trimester‌ ‌ 4‌‌weeks‌‌ ‌ ○ Fetal‌‌heart‌‌begins‌‌to‌‌beat‌ ‌ 8‌‌weeks‌‌ ‌ ○ organogenesis‌‌is‌‌complete‌ ‌ ○ head‌ ‌large‌ ‌in‌ ‌proportion‌ ‌to‌ ‌rest‌ ‌of‌‌ the‌‌body‌ ‌ 12‌‌weeks‌‌ ‌ ‌ ○ Embryo‌‌called‌‌fetus‌ ‌ ○ doppler‌‌can‌‌be‌‌used‌‌for‌‌FHB‌ ‌ MANIFESTATION‌‌OF‌‌PREGNANCY‌ ‌ Presumptive‌‌evidence‌‌of‌‌pregnancy‌ ‌ Second‌‌Trimester‌ ‌ a.‌‌Presumptive‌‌symptoms‌ ‌ 16‌‌weeks‌‌ ‌ Nausea‌‌with‌‌or‌‌without‌‌vomiting‌ ‌ ○ Quickening‌ ‌(earliest‌ ‌fetal‌‌ Disturbance‌‌in‌‌urination‌ ‌ movement‌‌felt‌‌by‌‌multigravida)‌ ‌ Fatigue‌ ‌ ○ Placenta‌‌completely‌‌formed‌ ‌ Perception‌‌of‌‌fetal‌‌movement‌ ‌ 20‌‌weeks‌‌ ‌ Breast‌‌tenderness‌‌and‌‌tingling‌‌sensation‌ ‌ ○ vernix‌‌caseosa‌‌and‌‌lanugo‌‌appears‌ ‌ b.‌‌Presumptive‌‌signs‌ ‌ ○ Quickening‌‌(primigravida)‌ ‌ Cessation‌‌of‌‌menstruation‌ ‌ 24‌‌weeks‌ ‌ Anatomical‌‌breast‌‌changes‌ ‌ ○ Active‌ ‌production‌ ‌of‌ ‌lung‌‌ Changes‌‌in‌‌vaginal‌‌mucosa‌ ‌ surfactant‌‌begins‌‌(Lecithin)‌ ‌ Skin‌‌pigmentation‌‌changes‌ ‌ Third‌‌Trimester‌ ‌ Thermal‌‌signs‌ ‌ ‌ ‌ PROPERTY‌‌OF‌‌ODLID‌ ‌ 29‌ ‌ ‌ CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌ ‌ ADOLESCENT,‌‌AND‌‌FAMILY‌‌ ‌ IDIANALE‌‌BATCH‌‌2024‌ ‌ ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌ ‌ ‌ Probable‌‌evidence‌‌of‌‌pregnancy‌ ‌ ‌ Wobbly‌‌gait‌ ‌ Enlargement‌‌of‌‌the‌‌abdomen‌ ‌ Leg‌‌cramps‌ ‌ Changes‌ ‌in‌ ‌size,‌ ‌shape,‌ ‌consistency‌‌of‌‌the‌‌ uterus‌ ‌ Anatomical‌‌changes‌‌in‌‌the‌‌cervix‌ ‌ Braxton‌‌Hicks‌‌contractions‌ ‌ Physical‌‌outlining‌‌of‌‌the‌‌fetus‌ ‌ Positive‌‌result‌‌of‌‌endocrine‌‌tests‌ ‌ ‌ Positive‌‌evidence‌‌of‌‌pregnancy‌ ‌ Identification‌‌of‌‌fetal‌‌heart‌‌tones‌ ‌ Perception‌ ‌of‌ ‌active‌ ‌fetal‌ ‌movement‌ b ‌ y‌‌ ‌ the‌‌examiner‌ ‌ 6.‌‌TEMPERATURE‌‌CHANGES‌ ‌ Recognition‌ ‌of‌ ‌embryo‌ ‌or‌ ‌fetus‌ ‌by‌‌ Slightly‌ ‌increased‌ ‌due‌ ‌to‌ ‌increased‌‌ ultrasound‌‌or‌‌radiological‌‌methods‌ ‌ progesterone‌ ‌ ‌ 7.‌‌ENDOCRINE‌‌CHANGES‌ ‌ SYSTEMIC‌‌CHANGES‌ ‌ Addition‌ ‌of‌‌placenta‌‌as‌‌another‌‌endocrine‌‌ 1.‌‌CIRCULATORY/CARDIOVASCULAR‌ ‌ organ‌ ‌ Physiologic‌ ‌Anemia‌ ‌Of‌ ‌Pregnancy‌ ‌(easy‌‌ Moderate‌ ‌enlargement‌ ‌of‌ ‌the‌ ‌thyroid‌‌ fatigability‌ ‌and‌ ‌shortness‌ ‌of‌ ‌breath,‌ ‌light‌‌ gland‌ ‌ hypertrophy‌ ‌of‌ ‌the‌ ‌heart,‌ ‌systolic‌‌ Increased‌‌size‌‌of‌‌the‌‌parathyroids‌ ‌ murmurs,‌‌nosebleeds)‌ ‌ Increased‌ ‌size‌ ‌and‌ ‌activity‌ ‌of‌ ‌the‌ ‌adrenal‌‌ Palpitations,‌‌increase‌‌heart‌‌rate‌‌(80-100)‌ ‌ cortex‌ ‌ Edema‌ ‌andVaricosities‌ ‌of‌ ‌the‌ ‌lower‌‌ Gradual‌ ‌increase‌ ‌in‌‌insulin‌‌production‌‌but‌‌ extremities‌ ‌ the‌ ‌body’s‌ ‌sensitivity‌ ‌to‌ ‌insulin‌ ‌is‌‌ Varicosities‌‌of‌‌the‌‌vulva‌‌and‌‌the‌‌rectum‌ ‌ decreased‌ ‌ Increased‌‌Level‌‌of‌‌circulating‌‌fibrinogen‌ ‌ 8.‌‌WEIGHT‌ ‌ 2.‌‌GASTROINTESTINAL‌‌CHANGES‌ ‌ 1st‌‌trimester‌‌weight‌‌gain‌‌is‌‌1.5-3‌‌lbs‌ ‌ Morning‌‌sickness‌ ‌ 2nd-3rd‌ ‌trimester‌ ‌weight‌ ‌gain‌ ‌is‌ ‌10-11‌ ‌lbs‌‌ hyperemesis‌‌gravidarum‌ ‌ per‌‌trimester‌ ‌ Constipation‌‌and‌‌flatulence‌ ‌ Total‌ ‌allowable‌ ‌weight‌ ‌gain‌ ‌during‌ ‌the‌‌ Haemorrhoids‌ ‌ entire‌‌pregnancy‌‌is‌‌20-25‌‌lbs‌ ‌ Heartburn‌ ‌ Pattern‌ ‌of‌ ‌weight‌ ‌gain‌ ‌is‌ ‌more‌ ‌important‌‌ 3.‌‌RESPIRATORY‌‌CHANGES‌ ‌ than‌‌amount‌‌of‌‌weight‌‌gained‌ ‌ Shortness‌‌of‌‌breath‌ ‌ PRODUCTS‌‌WEIGHT:‌ ‌ 4.‌‌URINARY‌‌CHANGES‌ ‌ 1. Fetus‌‌3400‌‌gms‌‌(7.5lbs)‌ ‌ Urinary‌‌f requency‌ ‌ 2. ‌Placenta‌‌450gms‌‌(1lbs)‌ ‌ Sugar‌‌in‌‌the‌‌urine‌ ‌ 3. ‌Amniotic‌‌fluid‌‌900gms‌‌(2‌‌lbs)‌ ‌ 5.‌‌MUSCULOSKELETAL‌‌CHANGES‌ ‌ 4. Uterus‌‌1100‌‌gms‌‌(2.5‌‌lbs)‌ ‌ Lordotic‌‌position‌ ‌ 5. Breast‌‌tissues‌‌1400‌‌gms‌‌(3‌‌lbs)‌ ‌ ‌ PROPERTY‌‌OF‌‌ODLID‌ ‌ 30‌ ‌ ‌ CARE‌‌OF‌‌MOTHER,‌‌CHILD,‌‌ ‌ ADOLESCENT,‌‌AND‌‌FAMILY‌‌ ‌ IDIANALE‌‌BATCH‌‌2024‌ ‌ ST.‌‌LUKE’S‌‌COLLEGE‌‌OF‌‌NURSING‌ ‌ ‌ 6. Blood‌ ‌volume‌ ‌1800‌ ‌gms‌ ‌(4lbs)‌‌ ○ Mask‌ ‌of‌ ‌pregnancy‌ 1500ml‌ ‌ 7. Maternal‌‌stores‌‌1800‌‌–‌‌3600‌‌gms‌‌(4‌‌ to‌‌8‌‌lbs)‌ ‌ Total‌‌11,000‌‌–‌‌13,000gms‌ ‌ (11‌‌to‌‌13‌‌kgs‌‌or‌‌24‌‌-28lbs)‌ ‌ 9.‌‌LOCAL‌‌CHANGES‌ ‌ UTERUS‌ ‌ ○ Weight‌‌increase‌‌–‌‌1000‌‌grams‌ ‌ ○ Shape‌‌f rom‌‌pear-like‌‌to‌‌ovum‌ ‌ ○ Hegar’s‌ ‌sign-‌ ‌softening‌ ‌of‌ ‌lower‌‌ segment‌‌of‌‌the‌‌uterus‌ ‌ ○ Operculum-‌‌mucus‌‌plug‌ ‌ ○ Goodell's‌ ‌sign-‌ ‌softening‌ ‌of‌ ‌the‌‌ cervix‌ ‌ ‌ VAGINA‌ ‌ BREASTS‌ ‌ ○ Chadwick’s‌‌sign‌‌-‌‌f rom‌‌light‌‌pink‌‌to‌‌ ○ All‌ ‌changes‌ ‌due‌ ‌to‌ ‌increased‌‌ violet‌ ‌ estrogen‌ ‌ ○ Leukorrhea‌ ‌-‌ ‌increased‌ ‌amount‌ ‌of‌‌ ○ Increased‌‌in‌‌size‌ ‌ discharges‌ ‌ ○ Feeling‌ ‌of‌ ‌fullness‌ ‌and‌ ‌tingling‌‌ ○ Ph‌‌of‌‌vagina‌‌-‌‌f rom‌‌normally‌‌acidic‌‌ sensation‌ ‌ to‌‌alkaline‌ ‌ ○ Nipples‌‌become‌‌more‌‌erect‌ ‌ SKIN‌ ‌ ○ Montgomery‌ ‌glands‌ ‌become‌‌ ○ Linea‌ ‌nigra-brown‌ ‌line‌ ‌running‌‌ bigger‌‌and‌‌more‌‌protuberant‌ ‌ from‌‌umbilicus‌‌to‌‌symphysis‌‌pubis‌ ‌ ○ Areola‌ ‌become‌ ‌darker‌ ‌and‌‌ ○ Melasma‌ ‌or‌ ‌chloasma-extra‌‌ diameter‌‌increases‌ ‌ pigmentation‌‌on‌‌cheeks‌‌and‌‌across‌‌ ○ Skin‌‌surrounding‌‌areola‌‌turns‌‌dark‌ ‌ the‌‌nose‌ ‌ ○ Colostrum‌‌formation‌‌by‌‌4th‌‌month‌ ‌ ○ Sweat‌‌glands‌‌unduly‌‌activated‌ ‌ OVARIES‌‌ ‌ ○ Striae‌‌gravidarum‌ ‌ ○ No‌‌activity‌ ‌ ‌ Chadwick‌‌sign‌‌-‌‌bluish‌‌discoloration‌‌of‌‌the‌‌cervix,‌‌ vagina,‌‌&‌‌labia‌‌resulting‌‌f rom‌‌the‌‌increased‌‌blood‌‌ flow‌‌(6‌‌-‌‌8‌‌weeks).‌ ‌ Goodell‌ ‌sign‌ ‌-‌ ‌softening‌ ‌of‌ ‌the‌ ‌cervix‌ ‌f rom‌‌ increased‌‌vascularization.‌ ‌ Hegar’s‌‌sign‌-‌ ‌‌softening‌‌of‌‌the‌‌uterus‌ ‌ Quickening‌‌‌-‌‌fetal‌‌movement‌ ‌ Ballottement‌‌‌-‌‌bouncing‌‌effect‌‌upon‌‌IE‌ ‌ ‌ ‌ PROPERTY‌‌OF‌‌ODLID‌ ‌ 31‌ ‌ ‌