NCMA217 LEC BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 PDF

Bachelor of Science in Nursing 2YA NCMA217 LEC: BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 o When the level of progesterone is high and the level of four Coverage for Midterm Exam:...

Bachelor of Science in Nursing 2YA NCMA217 LEC: BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 o When the level of progesterone is high and the level of four Coverage for Midterm Exam: hormones are low, the woman will not undergo labor and Intrapartal care delivery. Labor and delivery o But when the level of progesterone is low and the level of four Essential Intrapartal and newborn care (EINC) homes are high, the woman will undergo labor and delivery. Newborn Assessment (It will start to uterus to contract) (If the 4 hormones are low and progesterone is high, then the uterus is not contracting.) Postpartum care o When the end of the pregnancy, the placenta will be aging Postpartum complications o Oxytocin is the main hormone that is causing uterine contraction during labor and delivery. Oxytocin coming from posterior pituitary gland. LABOR AND DELIVERY o Prolactin is from anterior pituitary gland. Discussed by Prof. Francis Vasquez Remember: - The process where in all the products of conception are - When the 4 hormones are high, and the progesterone is expelled from the uterus (lumabas or kailangan lumabas) low then the uterus is contracting - Expulsion of all the products of conception. - Then, when the 4 hormones are low, and the progesterone - Different Products of Conception: Baby is low then the uterus is relax not contracting Placenta Premonitory Signs of Labor Umbilical cord Lightening – Primi – 1-2 weeks/ Multi – 1-2 days Amniotic fluid - Madalas lumabas sa board exam tong lightening. All the products must go out during the labor and delivery - Lightening is dropping of the baby and entrance of fetal - What will happen if one of the products of conception is presenting part. This is the earliest sign of labor remaining the uterus? Example. The baby is out, the amniotic - Entrance of fetal presenting part into pelvic inlet. (Head, fluid is out, the umbilical cord is out. But the portion of the buttocks, shoulder) placenta or part of the placenta is remaining on the uterus - 9th month, wala pang lightening – yung fundus nasa what will happen? xiphoid process. - Prone to infection - Late 9th month may lightening – yung fundus nasa 8th - Normal Consistency of the uterus: the uterus after the month level. delivery of the baby and the placenta must remain - Pag nagkaroon ng lightening, SOB is relieved, napunta sa contracted. baba yung pressure at nacocompress ung urinary bladder. - Contracted – firm Kaya mag increase yung urinary frequency and vaginal - What will happen if the uterus after delivery of the mother, discharge. after giving birth relaxes? - Pag wala pang lightening, there is increase - It begins to bleed; the uterus of the mother will bleed. infradiaphragmatic pressure. Meron pa syang SOB - Everything must go out - Lightening occurs because of the progesterone and relaxin. - Normally, the uterus is empty organ - Relaxin causing loosening of pelvic joints (kaya - Length of Gestation: nagkakaroon ng broadening of the hips) Kapag multi para 9 months ka na, mas mabilis na ang loosening ng pelvic joints. Lalo 37-42 weeks na kung ang delivery ng pregnancy mo ay sunod sunod. 280 days - During pregnancy pelvic joint are not yet loose - But when the woman enters the 3rd pregnancy the pelvis Hormonal Control of Labor will become broader. Because of loosening the pelvic joint and because of the 2 hormones - Primi is the earliest who experience lightening. - Multi is the fastest lightening. Weight loss - Because of increased tension and fatigues and nesting behavior. Increased tension and fatigue Cervical changes - Effacement and dilatation - Effacement: Internal OS (thinning) o Progesterone is the only one hormone that prevent uterine - Dilatation: External OS (widening and opening and contraction. softening of the cervix o There are four hormones helping one another to start labor. Nesting behavior – The woman is busy preparing the Oxytocin, estrogen, prostaglandin, and fetal cortisol is the materials that baby will used. hormones stimulate the uterine contraction. J.A.K.E 1 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 Rupture of bow - Once the uterus reaches the maximum of being stretch, Increased Braxton hicks’ contractions the endometrium releases prostaglandin to help the uterus - Painless irregular contraction during pregnancy. to contract, prevent uterine rupture. - There is high estrogen level (mataas lang konti) - When the prostaglandin is released, it will cause uterine - The contraction is painless because the progesterone level contraction; therefore, the products of the conception will is high. (mataas si estrogen pero mas mataas si go out. The end of the pregnancy, the PPG will produce progesterone kaya painless sya. Sana painless din kapag oxytocin causes uterine contraction. broken hearted ka, anhirap eh huhu HAHAHA charot) Placental degeneration theory - Nearing labor, progesterone is decreasing, estrogen and Progesterone deprivation theory oxytocin is increasing. The Braxton hicks’ contractions - When the placenta is aging or degenerating the ability of are painful and regular. Kaya nawawalan ng appetite. the placenta to produce progesterone decreases when Nababawasan ng 2-3 pounds of weight loss prior to labor progesterone decreasing deprive then no hormone will and deliver. prevent the uterus to contract, that is why the 4 hormones will increase. False VS True Labor - Lifespan of placenta is up to 9th month of pregnancy. And Pain originates from the abdomen (F) the main hormone that the placenta will produce is Pain originates from lumbosacral area (T) progesterone. Preventing contraction. Pain is intensified by walking (T) - Mag pinsan si placental degeneration theory at Pain is relieved by walking (F) (sana lahat ng pain nawawala progesterone deprivation theory. pag naglalakad hehe) (-) BOW (ruptured) (T) Stages of Labor and Delivery Intact BOW (F) Sedation decreases contractions (F) – sedation is drug Contraction is not affected by sedation (T) Contractions are progressive or regular (T) Contractions are irregular and non-progressive (F) No cervical changes (F) With cervical changes (T) effaces/ thinning – internal os and dilatation widening – esternal os. Presence of bloody show (T) – no bloody show (F) - Cervical dilatation of 4cm, effacement of 50%, intact o Code: D E P R BOW = true labor (woman can undergo true labor even - The stage of dilatation will start from the true labor to full the BOW is still intact, yan minsan ung nagpapatagal ng cervical dilatation labor nya) - Stage 2, from full cervical dilatation to delivery of the - Spontaneous rupture of the BOW – kaya minsan kapag baby nag poprolonged labor ka na dahil antagal pumutok ng - Stage 3, from delivery of the baby to delivery of the BOW = Amniotomy – intentional or artificial rupturing of placenta the BOW. - Stage 4, from delivery of the placenta to the first 2hrs - Why amniotomy? – ang sabi natin, ung rupture of water after the delivery will increase uterine contraction. So, kapag nirupture ni o Stage 1 dilatation is the longest duration because it is doc ung BOW at nag increase ung uterine contraction, the measured by cm. 1 to 10 cm of cervical dilatation. it takes time fundus pushing down faster the baby. Then the head of to cervix to dilate. baby will compress the internal os and magkakaroon ng o Since the stage 1 is the longest duration, it is composed of 3 thinning/ effacement ang internal os. Tas papunta na sya phases. Latent, Active and Transitional sa external os at mag da-dilate na sya. So the purpose of o The responsibility of the nurse during stage 1 is to monitor the amniotomy is to shorten the first stage of labor by progress of labor. Using this table ↓ increasing contraction. It improves station. Criteria Theories of Labor Onset Latent/ Active/ Transitional/ - How will labor and delivery begin Area Phase 1 Phase 2 Phase 3 Prostaglandin theory Cervical 0-3 cm 4-7cm 8-10cm Oxytocin theory dilation Uterine stretch theory Uterine Contraction - Magpinsan to sa prostaglandin theory. - The uterus is a hollow organ. When the woman gets Duration < 40 secs 40-60" 60-90" pregnant the uterus is filled by the products of conception. Freq. q 5 mins > q 3-5mins 1 1/2 mins - As the baby growing, the uterus will also grow – enlarges - But as the uterus enlarges, the uterus is thinning because Intensity mild-mod mod-strong strong of the uterus is being stretch Clients less cooperative Uncooperative Mood cooperative J.A.K.E 2 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 o Sa stage 1, ang ginagawa ng nurse ay minomonitor yung vital - Don’t take it literally that the baby is hanging on the signs, monitoring of uterine contraction, performing IE. uterus o The woman is cooperative in latent phase because the intensity Oxytocic Tocolytic is mild, the frequency is less frequent and when the uterus contract is only short. Syntocinon Duvadilan o During contraction in latent phase the woman is not Pitocin Dactyl OB experiencing a lot of pain. (naka ngiti pa yan si mommy, Oxytocin - EINC Yutopar madaldal pa sya) Methergine Bricanyl/Terbutline o In transitional she’s uncooperative because the intensity of a) Oxytocin uterine contraction is already strong. (Masakit na bhi3, ikaw kaya, pag heartbroken ka. Nalaman mo may iba na syang Syntocinon and Pitocin mahal, syempre masakit yon diba. Kahit daldal ng daldal ung - Given via IV incorporation (naka mix sya sa IV bottle) katabi mo, wala kang pake (uncooperative) kasi nga masakit - Masyado pinalalakas ang contraction. ung puso mo, gusto mo mag emote or magwala. Ganern - So, ang tendency ng uterus after delivery, ay mag relax. HAHAHHA sorri heartbroken kase nagtype neto hehe) Kasi nagamit na yung muscle tone o The uterus will contract for 90 seconds occurring every 1 and - Side effect: vasoconstriction and hypertension (sa half minutes – If the uterus contracts now and happen again in postpartum – uterine atony effect) 2 minutes. IV corporation o For duration – seconds; frequency – mins and seconds - You do not administer the drug in the white port or o Latent phase is the best time to teach the mother about the piggyback kase kapag ininject mo yung drug sa proper pushing because she is still cooperative. piggyback mag da-direct yung gamot sa pasyente, o The maximum duration of one contraction during transition is rather ang ginagawa mo sa drug is mini mix mo sya 90 secs only. Dapat ung intensity is strong, hindi very strong. doon mismo sa laman ng IV bottle. o Kapag lumalagpas sa 90 secs yung one contraction, the baby is - Particularly, the syntocinon, Pitocin, and oxytocin are fetal distress. Pag ganon, notify the doctor agad. not given to IV push o You need to monitor the fetal heart rate, fetal movement, and - Ex. 1 ampule of Syntocinon has 10 units, a total of color of amniotic fluid to know if there’s a possibility of fetal 2mL or 2cc and u have 1L of IV fluid. distress. - 1L = 1000mL - You incorporated the drug in the bottle. The mother 5 Ps of Labor and Delivery consumes all the 2mL Syntocinon, when the mother Power already consumes the 1L IV fluid kase minix mo sya Passageway doon. Meaning the nurse dilute the drug very well. Passenger - If you push the 2mL syntocinon IV push, the nurse Psyche administered pure drug Placental Factor - Ex. The woman is undergoing pre-mature labor 28 Drill: weeks pregnant (pre-term labor). Then when the baby 1) COC/ companion of choice – Psyche is delivered, it is pre-term baby. 2) Cervix – passageway - If the doctor can still stop the uterine contraction and 3) Maternal pushing – power save the pregnancy, then the drug that will prescribe is 4) Uterine contractions – power the Tocolytic drug to relieve the uterine contraction. 5) Attitude – passenger - Diba kase ang full term is 40 wks. 6) Multiple pregnancy – passenger - But when the woman is in true labor the woman 7) Vaginal canal – passageway cannot receive tocolytic drug 8) Prenatal check-up – psyche - The origin of the uterine contraction: Myometrium, 9) Abruption – placental factor Fundus, Upper uterine segment Power Oxytocin – EINC - Forces that push the baby out - Essential intropartal in newborn care. Oxytocin is not 2 Sources of Power During Labor given in IV incorporation; it is given by IM (intra- 1) Uterine contraction fundus muscular injection) to the mother 1 min after the baby is - Main source of power out or delivered. (Placenta is still inside) - Contraction originates from fundus, myometrium of the Methergine fundus in the upper uterine segment. - Given after the placenta is out. - 2 groups of drugs that will affect the uterus whether to - Nowadays the most common drug that is given is contract or relax: oxytocin no more methergine. a) Oxytocic – drug that stimulates the uterine - Pag hindi mo ninotify ung nurses’ station, hindi sya lalapit contraction (pamhilab) sa pasyente para magbigay ng Methergine IM. b) Tocolytic – drug that prevent or stop the uterine - After placenta is out, promote contraction and prevent contraction. It is relaxing the uterus (pang patanggal postpartum bleeding. ng hilab) (sometimes the midwife prescribes the - The different between the oxytocin and methergine: tocolytic drug as pampakapit) o Oxytocin promotes rhythmic uterine contraction o Methergine sustained contraction J.A.K.E 3 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 o Rhythmic uterine contraction – the uterus will dedefecate sya, kasi baka yan ung ulo ng baby, lumagpas contract, rest/relax. (vice versa) na ung ulo ng baby sa anal sphincter. o Sustained contraction – the uterus will continue to - Panting relaxes abdominal muscles. contract - If you will use methergine and accidentally administered the methergine before the placenta is out: C1 C2 o The placenta will not go out because the cervix will close. o When u accidentally administered the methergine by intramuscular to the mother before the placenta is out o Increment – start of the contraction it will promote sustained contraction. The uterus will o Achme – peak of the contraction continuously contract, and the cervix closes, and the o Decrement – end of the contraction placenta is trap on the uterus. - Between oxytocin and methergine which one has a higher Assess Uterine contraction as to: chance of causing hypertension to the mother: 1) Duration –increment to decrement o Both can cause hypertension or can elevate the blood 2) Interval – decrement to increment pressure of the mother. But the higher chances that 3) Frequency – increment to increment could cause is the Methergine, because it sustained 4) Intensity uterine contraction o If it sustained uterine contraction the blood vessels o What do you call A to B? – Duration (tagal ng hilab) are constricted. o Decrement to Increment? – Interval (pagitan ng hilab) o Therefore, before u will administered oxytocin or o Increment to increment? – Frequency (dalas ng hilab) methergine u have to check the blood pressure of the mother is less than 140/90 Situation: o If the blood pressure is reaches 140/90 and above. Do Mrs. Smith started to feel the contraction at 7:01 am that lasted for not administer both drug. U must notify physician 45 sec. This was followed by another contraction at 7:07 and 15 b) Tocolytic sec. What is the duration, interval, and frequency of her - They stop the uterine contraction. contractions? - Bricanyl / terbutline – bronchodilator na, ticolytic drug pa. They relax the smooth muscle of the uterus and that is myometrium. - It is given when u want to save the baby. - Ex. The woman is undergoing pre-mature labor 28 weeks pregnant (pre-term labor). Then when the baby is delivered, it is pre-term baby. Solution for Duration: - If the doctor can still stop the uterine contraction and save 7:01/ 45 – 7:01 = 45 seconds the pregnancy, then the drug that will prescribe is the Solution for Frequency: Tocolytic drug to relieve the uterine contraction. 7:07 / 15 – 7:01 = 6 mins 15 seconds - Diba kase ang full term is 40 wks. Solution for Interval: - But when the woman is in true labor the woman cannot receive tocolytic drug, the woman can receive oxytocic. - Example: A Pregnant woman is experiencing threaten abortion. The doctor ordered bricanyl subq, the patient ask u, what is the action/effect of this drug? – it relaxes the smooth muscle of the uterus. Hindi na isasama ung o 15 – 45 hindi pwede, so mag boborrow ka doon sa 7. Ung 7 bronchodilation kasi wala naming asthma si nanay. magiging 6 na. 2) Ability of the mother to bear down or push. (kakayahang o Binawasan natin ng 1min yung 7 kaya ang mapupunta sa 15 ay umire) 60 secs. Bali 15 + 60 = 75 secs. - No coach pushing. - Dapat fully efface (100%) and fully dilate (10cm) na sya, Situation: saka mag push. Mrs. Kent is on her 9th month of pregnancy. She is complaining of - Example: cervix 8cm dilated, 100% efface, rupture BOW, pain originating from her back that becomes intense whenever she positive 2 station – engaged na sya, do not push walks. Her bow broke 2hrs ago. Upon IE, the nurse noted 6 cm - 8cm dilated at 100% efface – bawal pa sya ipush pero ung cervical dilatation. Her uterine contractions are occurring every 4-5 nanay napapaire na (uncontrollable urge to push during mins strong in intensity. contraction) so para mawala ung urge to push, mag o True labor papanting na sya. - Kasi the pain is originating from the back. - Example: the woman undergoing through labor, she is - The pain is intensified by walking 8cm dilated and 100% effacement. During contraction, - Rupture of the bag water she feels the urge that she’s going to defecate. – ask the - Presence of cervical dilatation. woman to do panting first. Nafifeel ng nanay na mag o Stage 1 – active phase J.A.K.E 4 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 Situation: - The woman can undergo normal delivery is she have regular Mrs. Troy is at term and undergoing labor. She started to feel pre-natal checkup. Because she knows that there is no problem contractions at 9:55 am and ended at 9:56' 10". This was followed during labor and delivery. So, it could boost the confidence of by another contraction at 9:57' 40'' and ended at 9:58' 55"am. Her the woman during delivery cervix is 8cm dilated, (-) bow, +2 station. Examination reveals a vertex presentation with the back at the right side of her abdomen. Placental Factors She had 1 abortion and a stillbirth at 35 weeks. She left home her Placenta previa – problem is in the location of the placenta. twin sons born on the 39th week of pregnancy. Abruptio placenta – problem is the timing of separation. o GPTPALM ESSENTIAL INTRAPARTAL NEWBORN CARE - Gravida 4 – parity 2 – term 2 – preterm 1 – abortion 1 – Discussed by Prof. Francis Vasquez living 2 – multiple pregnancy 1 - Goal of ENC – To decrease both maternal and neonatal - G4P221121 morbidity and mortality rates by 40%. o Stage and Phase of Labor - Maternal morbidity – sickness or illness of the pregnant - Stage 1 – transitional phase woman. During pregnancy, during labor and deliver, and after o Duration, frequency, interval of Ucs delivery. - Duration in 1st contraction – 70 secs - Maternal mortality – deaths of the woman related to pregnancy, - Duration in 2nd contraction – 75 secs labor and delivery, and after delivery. - Frequency – 2mins and 40 secs - Neonatal morbidity – illness of the newborn in the 1st 28 days - Interval – 1min and 30 secs of life. o Presentation, presenting part, lie, attitude, and position - Neonatal mortality – death of the infant in the 1st 28 days of - Presentation – cephalic life. - Presenting part – vertex/ occiput - Ung neonatal morbidity and motality hindi naachive ng ENC - Lie – longitudinal ung 40%, 20% lang. Kaya inimprove nila ng EINC - Attitude – flexion - ENC was the answer of the WHO, DOH to Millennium - Position – right occiput anterior development goals (MDG) Nos 4 & 5. o Auscultation site of FHR - From MDG to Sustainable development goals - Right lower quadrant - MDG No. 4 – child health Passageway - MDG No. 5 – maternal health - This pertains to the birth canal 1) Pelvis – types and diameters Pre-pregnant Updates for Childbearing age Women: 2) Cervical canal – effacement and dilatation - Childbearing age women – married, sexually active. Mga 3) Vaginal canal – ability to distend capable na mabuntis. - The best type of the pelvis – Gynecoid and anthropoid - Healthy lifestyle – exercise, avoid smoking and alcohol. - The AP diameter of the inlet – 11 diameters, Transverse – 13, - Smoking – vasoconstriction, low oxygen, and nourishment Outlet – 13 supply of the baby. Small gestational age, maliit ung baby, Passenger maliit din ung utak at mababa din ang IQ (undeveloped brain) The fetus - Alcohol – neurologic impairment – irreversible; cognitive - Number: 1 baby/preg impairment – affects the brain, the ability of the baby to - If there is multiple pregnancy magkakaroon ng additional process ideas to think. problem malpresentation - Health teachings on: - One baby is in cephalic, one baby can be in breech STD prevention, family planning and contraception presentation Nutrition requirements: - Size: 2.5kg; Ave: 3kg – 4kg o Calories – 2,000/ day - Attitude: flexion o Iron – 30 mg/ day - Presentation: cephalic o Use of iodized salt (iodine supports brain - PP: vertex/occiput development of your future baby) - Position: LOA, ROA, OA Antenatal Updates - Common position: LOA, Lie: longitudinal - Buntis na sya dito. Psyche - Prenatal Checkup – facility-based checkup (4) - The mental, psychological, and emotional preparation of the - Facility-based checkup – health center. woman to undergo labor and delivery - Minimum of 4 checkups – before the 4th month, 6th, 8th and 9th. - COC: companion of choice - Healthy lifestyle – exercise (walking), avoid smoking and - To provide continues maternal support. alcohol - Allowed to enter labor room - Health Teachings on: - Allowed to be with the delivery woman inside the STD prevention delivery room. Family planning & contraception (ituturo mo yan: - The husband is the best companion of choice antenatal, pre-pregnant and Postpartum) - Remember: a woman can carry normal delivery is allowed to Newborn Screening – assessment test that will determine choose to bring one companion during delivery. the husband is if the baby has metabolic disorder because this can cause the best companion of choice. cognitive impairment. - Regular prenatal check up J.A.K.E 5 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 Nutritional requirements: Inside delivery room: o Calories = 2,300 - 2,500/day Prepare DR environment: o Iron = 60 mg/day Set temperature of DR between 25-28 C o Folic Acid = 400 mcg/day (prevents neural tube Eliminate air drafts (mag hawak ng tissue paper sa loob, defect, spina bifida – may kulang ng parte ng buto sa kung malakas ang uga, meron pumapasok na hangin from likod) the outside, it can reduce the temp, ang baby pwede ma- o Calcium = 1,200 mg/day hypothermia) o Protein = 60 gm/day Turn off AC unit just before baby is out o Vit A 10,000 iu (binibigay sa 2nd trimester 4th month) Safe delivery techniques: (not on the 1st trimester because of teratogenic Semi-upright position effects) No more routine amniotomy (kasi pag masyadong maaga, o Elemental Iodine = 250mg 1 cap/ pregnancy (4th baka magkaroon ng infection) amniotomy – artificial month) intentional rupturing of the bag of water. Purpose – o Increase fiber & fluid – to prevent constipation. increase uterine contraction. - Exercise during pregnancy: No more routine episiotomy (kung tingin ni doctor ung Walking size ng baby can pass through the birth canal without Pelvic rocking – relieves backache creating episiotomy, then don’t do episiotomy) Tailor sitting – makes perineum supple With COC Squatting – strengthens perineal muscles No coached pushing Kegel’s exercise – strengthens perineal muscle No fundal pushing Perform Ritgen's Maneuver (is done to deliver the head of The administrator of antenatal steroid to a pregnant woman the baby to prevent lacerations) - Use: to improve fetal lung maturity by increasing the production of surfactant. Check for cord coil - When: 24 – 28th week of pregnancy (6th – 7th months kasi ang Oxytocin IM 1 min after baby is out fetal alveoli will produce surfactant starting 6th months) Active management of the 3rd stage labor - Surfactant lubricates the alveoli. No more Brandt-Andrew's Maneuver - Who: 4 criteria – Controlled Cord Traction with Counter-Traction 1) With history of preterm birth (22 -36th weeks) No Cord milking 2) At risk of preterm birth (hypertension, diabetes mellitus, No more Methergine IM Anemia) Perform 4 Newborn Protocols 3) with history of vaginal bleeding during the present 4 newborns protocols pregnancy 1 30 secs st Dry the baby Hypothermia 4) Experiencing actual preterm labor (1 dose is enough kaya Hypoglycemia and ang ibigay benta na higher dose) Next 30secs Skin to skin contact infection - What: Timely cord Dexamethasone = 6 mg IM q 12 hrs x 4 doses (ilan araw 1-3 mins p birth Anemia clamping cutting makompleto ung dexa – 12 x 4 = 48 hours/ 2 days) Encourage Breast Betamethasone (Celestone) = 12 mg IM q 24 hrs x 2 1st 90 mins p birth Skin to skin contact feeding doses (ilan araw makompleto ung beta – 24 x 2 = 48 houts/ 2 days) ESSENTIAL INTRAPARTAL NEWBORN CARE Intrapartal updates Discussed by Prof. Jhal Espinosa At labor room: - It is a package of evidence-based practices recommended by Admit at active phase (2 signs of that the woman had enter the the DOH and PhilHealth. active phase of labor: 4cm CD or 2-3 UC in 10 mins pero ang - It was initiated by the WHO. common na gnagamit ay 4cm of cervix dilation) - Considered to be standard of care in all births. With COC companion of choice – continues maternal support. - Hindi lang gnagamit to sa government to, ginagamit din to sa Any upright position (standing, walking, sitting, squatting) private hospital, specifically doon sa mga baby friendly (advantage: gravity pulls the baby down) (purpose: shorten the hospitals. 1st stage of labor) - Worldwide No more NPO – early digested food (more on carbohydrates – - It is also considered as a comprehensive strategy design to for energy to push) lower down the rate of mother and child mortality and No more IV fluid morbidity. No more IV incorporation of oxytocic Perform IE 30 strong - Systematic approach helps to ensure the pertinent data are not respirations 0 irregular cry vigorous cry overlooked. (kaya meron tayong system na finofollow kasi para mas systematic or sunod sunod ang ating assessment sa Interpretation Nursing intervention bata.) 1st examination 0-3 Severely depressed Immediate resuscitation - Monitoring the baby inside the womb of the mother before. The delivery and 2 hrs after birth 4-6 Guarded Suctioning - Habang naglalabor until the baby is delivered ina-assess mo Proceed to routine both mother and the baby. 7-10 Good prognosis newborn care 2nd examination - Doing an APGAR scoring lend 30 seconds dapat mabilisan - Before discharge (Elay: para di ka maunahan galaw galaw naman dyan preee emzz, Aki: - Assess pa din si baby if there is any complications or yung inunahan ko na nga pero mas pinili nya pa ung bagong dating ouch) mga health teaching for the both parents. - Acrocyanosis – nagiging bluish ung extremities ni baby at - Kapag wala naman problema, 24-48 hours minsan naaffect oral cavity. - Cesarean – 5days - For fast assessment of APGAR just think the total score “10” then 3rd examination minus lang kapag may nakita ka habang inaassess si baby. Any division from the norm (2pts), minus 1 ka lang ng minus 1. - After 6-8 weeks of neonatal life - Severely depressed: 0-3 - Babalik na for follow up check up - Moderate depressed: 4-6 (baka ung baby super sedated, kasi si - Announcement of the doctor about the vaccines. mami ayaw nya makaexperience ng pain kaya si baby ay tulog 4 Phases of Assessment na tulog. Kaya ang gnagawa, sina-suction nlng si baby para Initial Phase mastimulate natin sya to cry.) pero hindi na to ginagawa by - Establish and maintain patent airway and support respiration. EINC, kapag kailangan lang, minsan kapag cesarean, hindi na - Kailangan makahinga sila from their nose so need mong e compress si baby doon sa vaginal canal kaya hindi nailabas ni suction agad after the baby delivered kase nasal breather ang baby ung mga secretions nya kaya minsan kailangan mag mga babies. suction para mailabas ung secretions na yon. - Maintain their temperature not too high, not too low - Excellent condition: 7-10 (just continue the newborn care) - 25 degree C to 28 degree C temp of the delivery room or the - CPR – two fingers lang. ICU. - 1st minute of assessment – how the baby tolerates the delivery - We also need to ensure safety and preventing injury and process. (gaano nya nakayanan ung pag process infection. We need to be able to know the actual and potential pagkakapanganak sakanya) problems: - 5th minute of assessment – how is the baby outside the uterus Actual – during the assessment u can see the existing (extrauterine life) how the baby accepting the outside of uterus problems. - 10th minute of assessment – if APGAR is good in 5th minute Potential – the baby is at risk to develop a problem. assessment pwedeng hindi kana mag continue sa 10 minutes of Transitional Phase assessment tuloy tuloy mo na pag aalaga sa baby. - Continuation of care (tuloy tuloy lang) - Transitional assessment: - Nursing goal: is continuously protect the newborn. We also - 1st stage: last for 6 – 8 hrs, first 30 min. awake and remaining facilitate a development of a close relationship specifically hours the newborn will be sleeping. with mother. - 6 – 8 hrs the baby will show gestational age, Nature of the birth, Effect the birth on the baby J.A.K.E 10 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 - Sleep face – relax and fall asleep – this usually occurs within Assessment of Gestational Age the 1st two hours of life 1) Small for gestational age (SGA) - 2nd stage: 6 – 12 hrs observation should be made until the vital - The newborn is less than 10% of the ideal weight at the signs are established time of birth (2, 500 grams) - 6 – 12 hrs hyperresponsiveness, nagugulat na sila, - Usually sa mga smoker or alcoholic drinker si mami. nagrerepond agad sila sa extrauterine life. (Parang ikaw, nag hi 2) Large of gestational age (LGA) lang sayo si crush, kilig na kilig ka na dyan. Be hindi ka nya - The newborn is more than 90% of the ideal weight at the gusto, nagchachat lng sayo yan kapag kailangan HAHA ouch) time of birth (4,000 grams) - Hal. Naag BP ka sa mother tapos nasa dibdib yung baby naka - Macrosomia – babies that delivered by the mother who higa natutulog, pumipisik yung baby kapag nakakarinig ng has gestational diabetes tunog kahit mahina - Kapag malaki ang baby iniisip na may gestational - Skin color changes. Una pinkish sya nung pinanganak tapos diabetes na kaya need talaga i-check si mother after an hour nagsh show sya ng cyanosis. (minsan dahil sa - What if the mother is pumunta nalang na manganganak na surroundings. Room temp) without any prenatal check-ups? You don’t have - Kapag nawala na ung regular suppy of oxygenated blood information. So mahirap sya. kailangan na mag effort si baby, Nag de-decrease oxygenated - The doctor usually orders for glucose test. Dapat 0 blood and pH level nya at nag increase ung carbon dioxide. glucose ang lumabas. - Transitory asphyxia – resulting from deprivation of O2 to - Kapag diabetic si mother nasanay ang baby tendency is newborn infant magchi-chill si baby after cut yung umbilical cord kase - As we stimulate to cry the baby, mag oopen lahat ng alveoli ng dependent sya sa glucose ni mother lungs nya and then ma-ooxygenated si baby regularly. 3) Appropriate for gestational age (AGA) - The newborn is within the ideal range of birth weight Assessment of Gestational Age (2,500 to 4,000 grams – normal weight of the bay) - A systematic assessment of physical sign and neurological - If there is disproportion on measurement. Iisipin na agad traits help establish the newborns gestational age. na there is something wrong w/ the baby Ballard Scoring Criteria - You will think that the bay has gigantism or dwarfism - By Doc. Jeanne L. Ballard - Hal. Si mahal at mura dwarfism hindi na sila lumaki - One of the commonly used criteria for assessing the newborn Full term – pregnancy that reached 37 to 42 weeks AOG or infant beyond the post term - Assess the posture of the baby Pre-term – pregnancy that reached 28 to 36 weeks AOG - Kapag kiniliti ang paa dapat mag wa wide sya Post-term – pregnancy that has extended to or beyond 42 - The baby could flex the legs para makakuha ng score na 4 weeks AOG General Physical Examination Vital Sign Based on the EINC we could conduct assessment of the baby after the full breastfeeding and skin to skin contact with the mother bef. You touch the baby again General appearance – check for the posture of the baby Skin condition – sometimes pinapanganak sila may rashes na Skin turgor Crinkles Lanugo Birth mark Respiratory effort – ginagawa mo para makahinga ang baby Temperature – can be take through rectal (to check also for the patency of the anus) or axilla - EINC – hindi na pwede ung rectal temp kasi they considered that as an invasive procedure, and it may cause of problem in terms of traumatizing the rectal mucosa of the baby. - Normal temp: 36.5 to 37. 4C - Hypothermia: less than 36C (so dadagdagan natin ng covering si baby or hinaan ung aircon) Dubowitz Maturity Scale - Hyperthermia: more than 40C - Extensive and mahirap gamitin so hindi na sya ginagamit - Accurate temp is the anal temperature - Dati nung ginagamit ito kapag maganda ang G.A assessment - To check the patency of the anus if may butas ang pwet ni sa Dubowitz Scale that means the APGAR score will be baby (minsan walang butas ang pwet ni baby) perfect - Ngayon sa tempanic nalang or axilla temp ang ginagamit J.A.K.E 11 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 - Kapag lumabas na si baby papahinaan ang aircon and get - Teach the mother to make sure the area is dry (kaya di a tissue dapat hindi gumagalaw yung tissue or walang air pumapayag na gumamit ng bigkis na sinasabi para drop na mangyayari. sumexy at hindi lumaki ang tyan shanolll charrr) - Poikilothermic – madali sya mag respond sa temp change. - Bawal i-submerge sa bathtub kase prone to infection Assessing the patency of the Anus - Kapag stabilize na ang extrauterine ni baby you can have - Wait for the meconium to pass sponge bath. (Warm water) - It happens on the first 24 hours of life Body length: 47 – 54 cm - It tells us the anus of the baby is patent - 1st style: posterior fontanelle (diamond shape). Next, Respiration – count by observing the abdominal movements contour of the body to heel (alakalakan) then pwede mo and count in one full minute for accuracy na makuha ang LENGTH. - Gaano ka effort para makahinga si baby - 2nd style: start from the heel, down to the contour of the - Assessing rise and fall of the abdomen kasi si baby ay body and to posterior fontanelle then read the abdominal and nasal breather. measurement (pabaliktad) - Normal respiration: 30 to 60 cpm - 3rd style: wooden ilalagay lang si baby then mame - Tachypnea: more than 60 cpm measure na yung haba, then mamarkahan ang reading - Bradypnea: less than 20 cpm Body weight 2500 – 4000 gms - Hindi pwedeng 25 seconds lang ang ita-time mo dapat 1 FULL MINUTE kase newborn infant. Kapag hindi na Head and Face sunod hindi mo ma a-assess na yung baby is humihinto Normal Abnormal hinto ang breathing that could lead to Apnea. - Assessment of respiration: physical aspect, sensory aspect, - Microcephaly – Hc 35cm/ > disproportionately o Chemical factors – nalelessen ung oxygenated blood 14in (malaki) large because it is ¼ or nya tas nagiincrease ung carbon dioxide. - Widely separated sutures: 25% of the total body - Newborn infant breath to their nose. Hindi pa sila preterm, hydrocephalus, cerebral length marunong huminga sa bibig edema - Head circumference is - 3 weeks pa bago nila ma-realize na they could breathe - Bulging fontanelle: subdural 33 –35cm through their mouth hemorrhage, hydrocephalus, CHF - Fontanelles Pulse – you may use the apical pulse which is located on the - Delayed closure: rickets, - Anterior fontanelle – midclavicular bet. 4th and 5th inter coastal space left. Count in hypothyroidism, down syndrome soft and closes one full minute for accuracy - Caput succedaneum –swelling or - 9–18 months, diamond - Normal PR: 120 -160 bpm edema or a bump on newborn’s shape - Bradycardia: less than 120 bpm head shortly after delivery - Posterior fontanelle – - Tachycardia: more than 160 bpm - Cephalhematoma – a collection soft and 2– 4 months, Blood pressure – BP monitoring is not routinely done. The of blood between a newborn’s triangular average of systolic and diastolic pressure is 60/80 or 40- scalp and the skull. 50mmHg at 1-3 days of age. o Molding can be observed kase kaka deliver palang ni baby Anthropometric Measurement o Anterior fontanelle – 3-4cm long; 2-3cm wide To assess the body size, shape, and the composition of the o Posterior fontanelle – slightly smaller than the anterior newborn’s baby fontanelle (mas maaga nagc close) To compare the size with estimated period of gestation o Fontanelle: bulging that can create intracranial pressure o Kapag nakalubog, possible na gutom ang baby kaya pwede To identify if there are abnormalities in newborn painumin ng gatas para ma rehydrate ang baby. Head circumference: o Hydrocephalus – there is a lot of water or fluid in the head - 33-35.5 cm (biggest size of the body) causing compression of the brain Chest circumference: o Paano ire-release ang fluid or para ma-decompress and head? - 31 – 33 cm (nipple line) - By inserting VP shunt (ventriculoperitoneal shunt) brain - Mas malaki ang head kesa sa chest surgery. (craniotomy) - 2 to 3 cm smaller than the head - Ilalagay sa loob ng brain ang manipis na tubo going down Abdominal circumference: to the neck (inside) then going down to peritoneum (para - 31 -33 cm (same w/ the chest circumference) syang straw) bumaba ang fluid pababa sa excretory duct - Level of the umbilicus. para iihi ni baby ang fluid - The abdominal contour is rounded, protruding bec. of - Kapag si baby lumaki, bibitin na ang tube sa loob ng weak abdominal musculature (baby fat) katawan so kailangan palitan yung tube. - Note: remember the baby is still has umbilical stump - Hanggang hindi nareremedy yung situation ni baby ng (pusod). Take care of it, just little above from the navel hydrocephalus just keep changing the tube until you reach ang measurement. the full height of the baby to help excrete the fluids - The umbilical stump will fall off after 1 – 3 weeks - Toxic (parang relasyon nyo toxic na emmzzz) - 7 – 10 days healing of the navel J.A.K.E 12 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 o Caput succedaneum – normal lalo na kapag di marunong umere si mother. Nagiging cone shape kase lalabas papasok si baby during the power stage of the mother. o Mareresolve sya in couple of days o Anencephaly – absence of the brain and skull. Day die after a days They don’t survive for long time. Hair and Eyes Normal Abnormal Mouth and Neck - Preterm – fuzzy hair Normal Abnormal - Fine and silky hair - Turner’s Syndrome – low hairline - No deviation - Intact palate - Eye movements are not yet - Upper slant eye would - Epstein Pearls are one or two small - Excessive salivation coordinated indicate down syndrome round well circumscribed cysts are - Cleft lip - Eyelids maybe edematous for - Cataract is a sign of rubella present in the palate, a result of - Cleft palate 2 days and others extra load of calcium that was - Sclera may be pale in color - Conjunctivitis deposited in the utero (benign bec. - Iris is round - Nystagmus of the extra calcium) - No tears because lacrimal - Corneal reflex should be - Webbing of neck ducts are not yet fully mature checked - Newborn’s neck are usually short would indicate (linisan din to check also the o Strabismus – eyes hindi masyado pantay. Hindi align sa bagay turner’s syndrome baby’s neck baka hindi ma na tinitigan nya kase di pa naman sya nakakakita - Swelling of the neck detached) o Nystagmus – involuntary movement of the eyes. Kapag hindi maybe due to tumor - Head should be extended when agad na remedy it could cause affect balance coordination of and other examined the baby abnormalities o Dolls eye – kapag tinurn ang head ni baby naiiwan ang mata o You put a sterile gauze around your glove finger, tas papasok o Lacrimal ducts – form after 3 months nyo sa bibig ni baby, then ififeel nyo yung palate sa taas kung o Down syndrome – or mongoloid babies in colloquial term. may butas. Their eyes are slightly slant and their ears are flat o Turner’s syndrome – usually mga babae ito. o Cataract – caused by the mother who has congenital rubella. o Conjunctivitis – ophthalmic ointment Skin o Corneal reflex – magpa pass ka ng light dapat may reaction Normal Deviation - Pink in color, ruddy - Pallor would indicate anemia, Ears and Nose or reddish in color edema, shock hypoxia, and Normal Abnormal - Skin turgor: hypotension sensation of fullness - Cyanosis - Top portion of the external ears should be derived from the at the level of the eye Central Cyanosis presence of hydrated - Ear cartilage: pinna is firm, cartilage can Peripheral Cyanosis - Low set ears subcutaneous tissue be felt at the edges - CHD – Severe respiratory distress would indicate - Elasticity: when the - Instant ear recoil (kapag finold ang ear - Jaundice (Pathologic/Physiologic) genetic skin is pinched and dapat bumabalik) - Petechiae would indicate infection syndrome release, it will go - Tympanic membrane is grey - Edemas indicate over hydration, back again to normal - Normal infant can hear sound and can renal failure, coronary heart disease, - Lanugo stimulate moro reflex due to sudden noise anemia - Vernix caseosa - Forceps mark (dalawang bakal na - Mongolian spots – - Neonates are also nose breathers - Obstruction of parang tongs) Kapag na cocompress only Asian people - Noses are usually flattened after birth mucus plugs nagkakaroon ng neurological - Millia – white spot - Patency of the nasal passages should be - Flaring of problem causing seizure assessed nares o Acrocyanosis – bluish or purple discoloration of the hands and o To assess the patency of the nose ang gawin is takpan ang isa feet of the baby including the mouth (nawawala naman sya then check if the baby still could breathe in one nose (may air after 24 hrs. nakakabawas nga lang sa perfect score of the na lumabalas) then ganun din ang gawin APGAR scoring) o Kapag hindi mo naramdaman ang paghinga ni baby (grabe o Jaundice - occurs w/ in 24 hrs of life (masama ito) ibig sabihin naman po kamanhidan mo kung ganun charoooott) get a tissue the baby has the hemolytic disease. Pathologic jaundice – Hal. paper then itapat mo sya sa nose to check kung gumagalaw Merong RH incompatibility or RBO incompatibility ang blood yung tissue or hindi ng parents hindi compatible o Hemangioma – not life threatening but prone to bleeding kase o Neonatal Jaundice – lumalabas ang paninilaw after 3 to 5 days nga highly vascular ang area. Once the area punctured it will so ang gagawin is papaarawan (sunlight). It lasts for 10-12 days. The doctor will order a serum bilirubin and he will check J.A.K.E 13 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 bilirubin level. Then kapag Nakita na nya yun he will compute and order for photo exposure or Bili light exposure o Bili light exposure – nursing care: cover the eyes and genital. o Until 9am only wag masyadong ibilad sa araw o Problema dito sa pilipinas – ung mga mami, nag eexpose sila ng araw pero doon sila sa gitna ng kalsada, maraming smug and smoke kaya baka magkaroon ng respiratory problem si baby. Chest and Abdomen Normal Abnormal - Normal and absence of retractions - Proportion to the body - Chest retractions Spine and Anus - Normal circumference is 31 –33cm - Crackles sounds Normal Abnormal - Heart rate is 120 –160bpm during Spine - Spina bifida – neural tube - Nipple size 5 -10 mm auscultations - No mass or nodules defects - Witch’s milk - Normally straight - Meningomyelocele - Abdomen is protuberant - Distended Anus - No opening - Abdominal circumference: 31 –33cm abdomen (malaki - Patent - Liver can be felt at 1 –2cm below the ung tyan) - Passes of meconium within right coastal margin - Prominent liver 24hours after birth - Bowel sound is present. - Umbilical hernia - Umbilical cord two artery and one vein o Make sure mag auscultate ka muna bago ka mag palpate ng abdomen. Kasi pag inuna mo ung palpate, iiyak na agad si baby. o Make sure ung diaphragm ng stethoscope na prewarmed mo. o Witch’s milk – nag sesecrete ung chest ni baby ng milk. o Yung liver ni baby, pinapalpate natin sa side o AVA – importante na makita natin to kasi minsan kapag si baby may problem at birth, baka kailangan natin gamitin ung umbilical blood vessels or umbilical catheterization. Extremities o Umbilical hernia – lumabas ung AVA nya sa pusod Normal Abnormal o Omphalocele – birth defect sya sa abdominal wall. May butas Hands - Simian usually presence of ung abdominal wall. - Creases one straight crease in the hand - Complete Fingers and can be seen in client with Male and Female Genitalia Feet down syndrome Normal Abnormal - Creases - Syndactyl – the fingers or toes Male - Phimosis – hindi sya ma- - Full term – creases are webbed or joined and that - Prepuce covers the glans penis retract. Masyadong tight covering the entire the condition was present at - Scrotum with rugae and - Hypospadias - sole birth descended testes - Epispadias - Post mature – deep - Polydactyl – when a baby is - Urinary meatus should be at the - Cryptorchidism – creases over the born with an extra finger on tip of glans penis undescended testes - foot the hand or an extra toe on the Female - Premature – no creases or foot. - Labia majora covers the labia partially - Clubfoot is a congenital foot - Labia majora does not - covering the upper 2/3 of deformity that affects a child's minora and urethra cover the labia minora the sole bones, muscles, tendons, and - Pseudo menstruation (blood na indicate that the newborn - Complete fingers-no blood vessels lumalabas, that is part of the is preterm abnormal curvature maternal hormones being present in the baby) - Clitoris – prominent J.A.K.E 14 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 Reflexes POSTPARTUM CARE - Are involuntary movements or actions. Some movements are Discussed by Prof. Jhal Espinosa spontaneous and occur as part of the baby’s normal activity. - Refers to the medical and nursing care given to a woman Others are responses to certain actions. during the puerperium. Approximately 6 weeks after the - Tonic neck reflex – fencing reflex delivery of the neonate beginning from the time that you have terminated the labor. (hanggang sa mabalik ung mga reproductive organs sa non-pregnant state) - This period constitutes a physical and psychological adjustment. - 4th trimester of pregnancy Principles Puerperium - Postpartum period 6 weeks - Period of adjustment after the delivery of the baby when the anatomic and physiologic changes of our body is being reverse to the normal non pregnant state. Involution - Uterus goes back to the prepregnant state (pagliit ni uterus) Post-partum care - Immediate care of the mother and neonate after delivery. Post-partum goals - Aim to help the mother in the healing of the process. - To provide emotional support. Post-partum Goals 1) Promote normal uterine involution and return to the nonpregnant state. 2) Promote comfort and healing of pelvis, perianal, and perineal tissues. 3) Prevent or minimize postpartum complications. 4) Assist in restoration of normal body functions 5) Increase understanding of physiologic and psychological adjustment and changes 6) Facilitate newborn care and self-care by the new mother (baka mamaya di pa marunong baka primi palang so kailangan e- assist talaga ng malala sizt) 7) Promote the newborn’s successful integration into the family unit 8) Support parenting skills and parent newborn attachment 9) Provide effective discharge planning Physiologic Changes of the Postpartum Period The uterus - the sealing of the placenta site is accomplished by rapid contraction of the uterus immediately after the delivery of the placenta. With time, thrombi form w/ in the uterine site and permanently seal the area - Once na madetach ung placenta, ung attachment ng placenta sa placenta site is exposed already. There are blood vessels that is exposed in the area which can bleed. Then the uterus will start to contract, and this contraction will pinch the blood vessels, so that it will stop bleeding. And because of that pinching effect, there will be thrombi formation, and this will permanently seal the openings left by the placenta. So, the uterus will no longer bleed, and we won’t have any problem with hemorrhage. - The uterus contracts firmly after delivery of the newborn and reducing the size of the uterus. The uterine contraction allows it to involute para sya ay mag return sa normal size. J.A.K.E 15 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 - Pagnailabas na si baby, biglang bababa yan hanggang sa level Lochia Duration Color Amount ng umbilicus. Mag stay sya doon for about 2 days and after Moderate in that, every day it will go down by one finger breadth (1cm). Rubra 1-3 days Red amount - Then after 10-14 days or 2 weeks, the uterus should not be palpable anymore. Because the uterus is already inside the Pinkish to brown 4- Decreased in pelvis. Serosa 3-10 days 6th day pinkish amount - Healing nun pinagiwanan ng placenta in the endometrium, that 7-9th day brownish will take approximately 6-7 weeks to permanently heal. 10-21 days Minimal in Alba Cream white - Endometrium starts to regenerate – 6 weeks (up to 6wks) amount - May pain si mami kapag na iinvolute kasi nag cocontract. Discomfort. The Cervix - Analgesic drug e.g paracetamol to reduce the pain - It becomes thicker and firm. Childbirth results in a permanent - Nursing care: continue breastfeeding, because as the baby change in the cervical os from round to elongated sucks on the breast, more oxytocin is being produce. And - Complete cervical involution may take approximately 3-4 because of that the contraction will go into a normal months. (cervical involution – going to go back to non- contraction and it will hassle the involution. pregnant state but it will not take the same form during the time na hindi pa sya nabubuntis) - Ung hindi pa nabubuntis ung babae, bilog pa ung butas ng cervix nya, pero after delivery of the baby, it will shrink, up to 1cm but the shape is elongated. It has experience tremendous trauma because of the passing baby. - Cesarian – may changes din sya pero hindi lng sya masyadong elongated. Kasi may mga nag ta-trial labor before cesarian section. The Lochia The Vagina - Uterine flow consisting of blood, fragments of decidua, white - It is smooth and swollen, blood cells, mucus, and some bacteria w/ poor tone after delivery - Last for 3 weeks after the baby is born. - Rugae re-appear by 3-4 - Kung normal spontaneous delivery si mami, the mother and weeks baby will stay in the hospital 1-3 days. Pero kapag cesarian, 5- - Hindi na bumabalik sa 7 days. original na itsura kasi - Rubra: the reason of being dark red color is it contains there will be scar epithelial cells, erythrocyte, decidua, odor – characteristic formation bcz of the human odor. (parang regla ung amoy). Makikita sya in 1st – 3rd episiotomy. day. - There is a surgical - Serosa: pinkish – contains serosanguinous discharge procedure to repair a containing decidua, erythrocytes, leukocytes, cervical mucus vagina sa mga gusto pang and microorganism. May mga microorganism na sya kaya mother na maayos yung malakas na ung odor nya kaysa nun rubra. part. - Alba – albicans, nag eextend pa sya ng 6 weeks. It contains The Perineum leukocyte, decidua, epithelial cells and fats (kaya light color - It appears edematous and bruised after delivery sya). No odor or very slight odor. Slight bacteria. - Episiotomy or laceration may be present. - The mother and father should wait until the secretions or - There will be pain. discharges of the lochia stop before doing sexual intercourse. - Nursing care: position her sims position. Nakadapa na And you must also consider the healing of episiotomy. 21 days nakagilid, put a pillow under the flex leg so that lalabas ung or maximum of 6 wks. isang paa, mas mababa ung extend ng paa, so magkakaroon ng - 6 weeks after birth the woman will menstruate, that is for non- gap or space in between the legs, so there will be more space lactating mothers. While for lactating mothers, it will take for the perineal area. approximately 24 weeks or 6 months for menstruation to - Nursing consideration: engorge breast, kaya it’s kind of return. difficult to position the mother in sims, kasi madadaganan ni - Kapag hindi agad bumalik ang mens ng mother pero hindi mami. Kaya dapat mag pa breast milk muna si mami bago sya nagla lactate its normal lalo nap ag regular yung mother but in mag sims position. nursing care kailangan kapag ganun is mag family planning - After 24 hrs u can give ice pack for the edema sya kase baka hindi nya alam na hindi sya nagme mens but nago ovulate na pala sya tendency na pwede sya ulit mabuntis. J.A.K.E 16 of 21  CARE OF MOTHER AND CHILD AND ADOLESCENT LECTURE – BSN 2ND YEAR 1ST SEMESTER MIDTERM 2021 The Abdomen - The glomerular filtration rates remain elevated for about 5-7 - It remains soft, and flabby for some time after delivery days postpartum - Striae remain but lightens to silvery white - Dilated ureters and renal pelvis return to their nonpregnant - Assessment of the rectus abdominis muscle. state within 6-10 weeks after the delivery - During the pregnancy, the muscle separated from each other - Diuresis occurs within the 2nd to the 5th day after delivery. and that is normal. - Gumigilid si uterus. That can soften or make uterus baggy and - It can take several months to heal the muscles and move close that can lead to bleeding. Hindi sya makacontract dahil wala to each other. sya sa position nya. - Diastasis recti – the abdominal muscles getting stubborn. ayaw - If the bladder is always distended, that can lead to urinary nyang bumalik sa kanyang original form. Ayaw nya mag dikit retention then it can lead to urinary tract infection. uli. (Aki: kaya wag ng pilitin ibalik ung dati. Kasi kahit anong - Adequate bladder emptying resumes 5-7days. effort mo kung ayaw nya bumalik. Edi wag. HAHA jk leng - Kapag ung babae umiihi ng madalas pero trickles lng, may nemen. Elay: wag na balikan ang past wag marupok owkieee problema yon. Dapat ang normal, unang ihi ni mami 100-150 emzz) so, nagiging weak ung core ng body, it leads to back ml. pain. And ung belly nya name-maintain nya ung laki ng belly. - May also complain of dysuria – because of the damage in the - S&S – there is indentation in between, and the color becomes trigone in the bladder. bluish to purplish. Nursing care is to recommend that the client - Normal delivery – we catheterize the woman before delivery, performs exercises. (light – moderate exercises for abdominal) so that we can release the urine in bladder, so mag shishrink The Breast ung bladder and it will facilitate the passage of the descent of - During the 1st week after delivery, as the colostrum is the fetus. changing to mature milk, your breast will become full. - Catheterization is a dependent nursing function. (orange). One - This normal postpartum fullness usually lessens w/ in 3 to 5 time big time ang pag gamit sa orange, while the yellow kase days, if feeding or pumping does not adequately remove all the it uses for C-section. milk your body produces, engorgement may develop. - Nursing intervention: to encourage urination, offer a bed pan - Prolactin – hormone responsible in stimulating milk and u can alternately pour warm and cold water. That can production. This are being stimulated by rapid rack of the stimulate micturition. Also, kung ready to ambulate na sya at estrogen and progesterone level. hindi nahihilo (make sure there’s no orthostatic hypotension) - Breastfeeding mother – ung posterior pituitary gland ay mag Samahan nyo sa CR, and mag run kau ng water, ng patak sesecrete din ng oxytocin hormone para maka initiate ng let patak lng, and this sound will also stimulate the mother to void. down reflex or milk ejection reflex. (make sure u do not flash the toilet while naka upo si mami - She should regularly breast feed the baby, so that there will be kasi ung splash ng water from the toilet, that can have increasing amount of prolactin and oxytocin production para microorganism which can go to the perineal area and infect the tuloy tuloy ung production ng breastmilk. episiotomy) - Colostrum is present kailangan ni baby na makuha yan - Kapag wala tlg taung makuhang urine output, we need to - Breast engorgement – may occur in nursing and non-nursing notify the physician right away. mothers. Specifically, in 2nd or 3rd day because of vasodilation. The Circulatory System Ipabreastfeed nya lng si baby or minsan apply warm compress - The usual blood loss w/ a vaginal birth is 300 to 500 mL. para ma alleviate ng pain. - With cesarean birth, it’s up to 500 to 1000mL. - 1st day, there is a present of milk but not that much. Kase the - A 4-point decrease in hematocrit (proportion of RBC to bby is still not yet know how to suck well kaya kailangan e- circulating plasma) and a 1-g decrease in hemoglobin value assess and breastfeeding teaching so kapag natuto na si baby occur w/ each 250mL of blood lost. mas madami na yung pag labas nung milk. - Para malaman natin na 500 ml ung lumalabas na blood, use regular size of kidney basin because that can accommodate