Care of Mother Prelims PDF

1 Care of Mother, Child, Adolescent TERMS USED TO DESCRIBE FETAL GROWTH Ovum: from ovulation to fertilization Heart Rate (HR) x Stroke Volume (SV) = CO Zygote: from fertilization to implantation Embryo: from implantation to 5-8 weeks...

1 Care of Mother, Child, Adolescent TERMS USED TO DESCRIBE FETAL GROWTH Ovum: from ovulation to fertilization Heart Rate (HR) x Stroke Volume (SV) = CO Zygote: from fertilization to implantation Embryo: from implantation to 5-8 weeks Heart Rate (HR): Measured in beats per minute (bpm). Fetus: from 5-8 weeks until term Stroke Volume (SV): Measured in milliliters (mL) per beat. Conceptus: developing embryo and placental structures throughout pregnancy MEASURE HEART RATE (HR): Age of Viability: earliest age at which fetus survive if they Clinical Method: Use a heart rate monitor or are born is generally accepted as 24 weeks or at the point a obtain a pulse reading manually at the wrist or fetus weight more than 500-600 g neck and count the beats per minute CARDIOVASCULAR SYSTEM Electrocardiogram (ECG): Provides a precise measurement of heart rate by recording the Beginning the end of the 3rd trimester, there is electrical activity of the heart. gradual increase of about 30-50% in total cardiac volume reaching its peak on the 6th months. MEASURE STROKE VOLUME (SV): This causes a drop in hemoglobin and hematocrit Echocardiography (Ultrasound): Non-invasively values since the increase is only in the plasma assesses the volume of blood pumped by the left volume (physiologic anemia of pregnancy). ventricle with each beat. MANIFESTATION: Cardiac Catheterization: Invasive procedure involving the insertion of a catheter into the heart Easy Fatigability and Shortness of Breathing dt to measure pressures and volumes directly Incrd. Workload of heart Other Imaging Techniques: MRI or CT scans can Slight hypertrophy of the heart also provide information about stroke volume. Systolic Murmur dt lowered blood viscosity Epistaxis dt marked congestion of the nasopharynx NORMAL VALUES as pregnancy progresses HGB CARDIAC OUTPUT MALE: 140-170 FEMALE: 120-160 Cardiac output (CO) is a crucial measure of the heart's efficiency in pumping blood throughout the HCT body. It represents the volume of blood the heart ejects MALE: 0.40-0.54 per minute and is a key indicator of cardiovascular FEMALE: 0.37-0.47 function. To calculate cardiac output, you need two main parameters: Heart Rate (HR): The number of heart beats per minute. Stroke Volume (SV): The amount of blood ejected by the left ventricle in one heartbeat. FORMULAS STROKE VOLUME: EDV (End Diastolic Volume) - ESV (End Systolic Volume) = SV CARDIAC OUTPUT: 2 Care of Mother, Child, Adolescent CARDIOVASCULAR SYSTEM VARICOSITIES OF THE VULVA AND RECTUM (HEMORRHOIDS) MANIFESTATIONS: due to poor circulation and pressure from the Palpitations dt sympathetic nervous system stimulation growing fetus. during first half of pregnancy and increased pressure of uterus against the diaphragm during 2nd half of pregnancy. MNGT: MNGT: Gradual slow movement Prevent Constipation (Incrd H20, fiber) SIDE0LYING POSITION WITH HIPS ELEVATED ON Edema of the Lower Extremities dt pressure of the PILLOWS; ADVISED MODIFIED KNEE CHEST gravid uterus on the blood vessels of the lower Administered stool softener, Docusate Sodium extremities. (Colace)Gentle finger pressure Applying witch hazel, cold compress, OTC MNGT: Raise legs above hip levels; Rest at left side-lying hemorrhoid cream for pain position (increases kidney's Glomerular filtration rate + good venous return) Administered Hydrocortisone-Pramoxine (Proctofoam-HC) - safe for fetus * S PROTENURIA AND HPN = All gooooooooooooooods THROMBUS FORMATION VARICOSITIES ON THE EXTREMITIES dt increased level of circulating fibrinogen that is Development of Tortuous Leg veins why pregnant women are normally safeguarded against undue bleeding. However, this also Dt the weight of the uterus (puts pressure on the predisposes them to formation of blood clots veins returning blood from the lower extremities (thrombi). → blood pooling and vessel distention-> enlarged, inflamed, and painful vein) MNGT: AVOID MASSAGING SINCE BLOOD CLOTS CAN BE RELEASED AND CAUSE THROMBOEMBOLISM. At Risk: c Fam hx, obese, large fetus, multiple pregnancy THROMOPHLEBITIS OR DEEP VEIN THROMBOSIS If left untreated, give supportive measures (DVT) MNGT Venous Inflammation with Thrombus Formation Rest in sims position / on the back c the legs raised (+) Homan's Sign - PAIN ON CALF UPON DORSIFLEXION against the wall c a small firm pillow under their Milk Leg or "Phlagmasia Alba Dolens" SHINY WHITE LEG right hip / elevated on a foot stool for 15-20mins BROUGHT BY STRETCHING AND INFLAMMATION OF THE BID as precaution SKIN Remind not to sit in cross leg or their knees bent, avoid constrictive knee-high hose or spanx MNGT: No to prolong sitting, do walk break Use of support hose or elastic stockings to CBR; AVOID MASSAGING promote venous flow thus preventing statis, apply ADMINISTER HEPARIN (NEVER GIVE COUMADIN) elastic bandage starting from the distal AVOID ASPIRIN - AGGRAVATE BLEEDING (ANTIDOTE PROTAMINE SULFATE) BLOOD PRESSURE may drop slightly in SECOND SEMESTER Dt when she lies on her back and uterus presses on inferior vena cava -> impaired blood return to heart SUPINE HYPOTENSION SYNDROME MNGT: Turn onto side to removed pressure in vena cava SIDE LYING POSITION (BEST ON LEFT) if at back, add pillow at the right hip 3 Care of Mother, Child, Adolescent HEPARIN V.S. WARFARIN Oral Iron Supplements (FERROUS SULFATE 0.3G. WARFARIN HEPARIN TID), best given 1 hour before meals or with an ‘’War-K-IN’’ ‘’H-P-PTT’’ empty stomach for better absorption, however can lead to GIT irritation Hence, given in full War: farin H: eparin stomach but with Vitamin C to enhance absorption K: ANTIDOTE -> Vitamin K P: ANTIDTOTE -> IN: INR -> 2 to 3 range Protamine Sulfate PTT: 40 to 70 max range GASTROINTESTINAL SYSTEM "WAR farin? So slow" = MORNING SICKNESS SLOW ONSET "HEP HEP! you’re to FAST" = FAST ONSET NAUSEA AND VOMITING during the first trimester are common due to the PHYSIOLOGIC ANEMIA increase HCG and progesterone. It may also be due to increased acidity or even to emotional factors dt hemodilution of the blood MNGT: THE MORNING GIVE PRY OR TOAST OR There is a 45-50% increase in blood volume expansion, of CARBOHYDRATES CRACKERS 30 MINS MWSERFARBE which about 75% in plasma and 25% is RBC. BEFORE LAWSIPICES ARISING IN ON THE DIET. Normal Values in Pregnancy: HYPERREMESIS GRAVIDARUM Hct: 32-42% excessive nausea and vomiting which persists beyond 3 Hgb: 10.5-14g/dL months which can result in dehydration, starvation and acidosis. May result to METABOLIC ALKALOSIS Criteria: Hct and Hgb should not fall: MNGT: D10NSS 3000ML IN 24 HOURS, COMPLETE BEDREST 1st and 3rd Trimester: Hct cervix softens BRAxton = HARDening and increased vascularity -> cervix darken from pale pink to a violet hue, Cervical Changes Consistency: Non-Pregnant: Nose Pregnant: Earlobe 7 Care of Mother, Child, Adolescent Just before labor, cervix becomes so soft like a DISTRIBUTION OF WEIGHT GAIN DURING PREGNANCY consistency of a Butter “ripe” for birth. VAGINAL CHANGES CHADWICK SIGN An increased in vascularity of the vagina parallels the vascular changes in the uterus Dt the increased in circulation -> changes in the color of vaginal wall occurs -> normal light pink to deep violet SIGNS OF PREGNANCY Ph level: Before Preg: > 7 (Alkaline) During Preg: 4 or 5 (Acidic) Goods for vaginal resistant to bacterial invasion This is dt the action of LACTOBACILLUS ACIDOPHILUS – a bacterium that grows freely in the increased glycogen environment -> increased lactic acid content BREAST CHANGES First physical changes of pregnancy a person notices (at about 6 weeks) PRESUMPTIVE- S/S woman may expi that SUGGEST MANIFESTATIONS: Feeling of fullness, tingling, and PREGNANCY but aren’t definitive tenderness. PROBABLE- indicative yet STILL not conclusive Dt increased stimulation of breast tissue by high estrogen level, Areola darkens, diameter increases from 3.5cm (1.5 in) to 5 or 7.5 cm (2 or 3 in) 16th week, COLOSTRUM, a thin, watery, high- protein fluid (precursor of breast milk) can be expelled As vascularity of breast increases, blue veins may become prominent over the surface of the breast in light-skinned pips. A sebaceous gland of areola, MONTGOMERY TUBERCLES, helps nipples supple and help to prevent nipples from cracking and drying during lactation, enlarge, and become protuberant During the first trimester, weight gain of 1.5-3lbs. On the 2nd and 3rd trimester, a weight gain of 10-11 pounds per trimester is recommended. Total allowable wt. gain during the entire pregnancy is 20-25 lbs or 10-12kgs. Pattern of weight gain is more important than the amount of weight gained. 8 Care of Mother, Child, Adolescent MATERNAL ADAPTATION HEALTH TEACHING: TO PREGNANCY Responsible Parenthood PSYCHOLOGIC FIRST TRIMESTER: ESTABLISH AN ACCEPTANCE OF PREGNANCY No tangible S / SX. Surprised, Ambivalence, Emotional Lability, Money Worries, Body Image Changes. Denial – Maladaptation to Pregnancy. Developmental Task: To accept the biological facts of pregnancy. “I AM PREGNANT”. HEALTH TEACHING: Bodily Changes Personal Hygiene Nutrition SECOND TRIMESTER: CONTINUATION OF PREGNANCY With tangible S / SX. Role identification and heightened sense of time Mother identifies fetus as a separate entity due to QUICKENING. Mother begins to fantasize the appearance of the baby. Change in sexual interest; father examines his own ability to parent. Developmental Tasks: To accept the growing fetus as a baby to be nurtured. “I AM GOING TO HAVE A BABY” HEALTH TEACHING: Growth and development of the fetus. THIRD TRIMESTER: PREPARATION TO SEPARATION OF THE BABY The mother has personal identification of the appearance of the baby. Mother has fears due to enlarged abdomen. Allow her to hear FHT. Labor and delivery are on mother’s mind. Nesting behaviors: Busy days and restless nights. Father prepares for birth and his involvement. Developmental Tasks: To accept the growing fetus as a baby to be nurtured. “I AM GOING TO BE A MOTHER”