Maternal Child Nursing Review of Anatomy & Physiology PDF

CAP 1 MATERNAL CHILD NURSING NORMAL MCN ABNORMAL MCN ANTENAL CARE HIGH RISK PREGNANCY INTRAPARTAL CARE PEDIA DISORDERS POSTPARTAL GROWTH AND DEVELOPMENT  REVIEW OF THE ANATOMY & PHYSIOLOGY I. External Genitalia/...

CAP 1 MATERNAL CHILD NURSING NORMAL MCN ABNORMAL MCN ANTENAL CARE HIGH RISK PREGNANCY INTRAPARTAL CARE PEDIA DISORDERS POSTPARTAL GROWTH AND DEVELOPMENT  REVIEW OF THE ANATOMY & PHYSIOLOGY I. External Genitalia/Vulva/ Pudendum 1. Mons Pubis/ Mons Veneris –adipose tissue lies over symphysis pubis; covered by pubic hair 2. Labia Majora- 2 folds of adipose tissue, thicker - protects external genitalia, vagina, distal urethra 3. Labia minora – hairless folds of connective tissue with mucous membrane 4. clitoris – pea-shaped erectile tissues & nerve endings 5. Fourchette- posterior joining of the labia minora; episiotomy site 6. vestibule- almond-shaped containing urinary meatus, Skene’s gland, hymen, vaginal orifice, Bartholin’s gland  REVIEW OF THE ANATOMY & PHYSIOLOGY I. External Genitalia/Vulva/ Pudendum 7. Urinary meatus - urethral opening 8. Skene’s gland / Paraurethal gland – secretes mucus for lubrication during coitus 9. Bartholin’s gland / paravaginal gland – secretes alkaline substance neutralizing the vagina to keep the sperm alive 10. Vaginal orifice – external opening of vagina 11. Hymen – membranous tissue covering the vaginal orifice 12. Perineum – muscular structure between vagina & anus  REVIEW OF THE ANATOMY & PHYSIOLOGY II. Internal Genitalia  passageway of fetus & menstruation  Dilatable canal  6-7 cms  rugae – thick folds of membranous stratified epithelium permitting stretching without tearing  REVIEW OF THE ANATOMY & PHYSIOLOGY III. Uterus  Hollow, pear-shaped organ for containment & nourishment of fetus  Function: menstruation pregnancy labor  Size: non-PG – 2.5 cm thick, 5 cm wide, 5-7 cm long  Shape: non-PG- pear-shaped PG – ovoid  Weight: non-PG- 60 gms PG – 100 gms  REVIEW OF THE ANATOMY & PHYSIOLOGY III. Uterus 1. Fundus – upper cylindrical layer 2. Isthmus short segment between body & cervix 3. Body – corpus; expands to accommodate fetus 4. cervix - lower uterine segment  REVIEW OF THE ANATOMY & PHYSIOLOGY III. Uterus Layers of the Uterus 1. endometrium – innermost - basal layer -glandular layer 2. Myometrium –muscular layer; contracts during labor and delivery; constricts the junction to prevent regurgitation of menstruation 3. Perimetrium – outermost layer - adds strength and support Decidua – specialized layer of the endometrium 1. decidua basalis – endometrium lies directly under the embryo 2. decidua capsularis – endometrium that encapsulates the surface of the trophoblast 3. decidua vera – remaining portion of the uterine lining  REVIEW OF THE ANATOMY & PHYSIOLOGY IV. Ovaries - 4 cm X 2 cms, 1.5 cm thick; almond-shaped, grayish-white - functions: produces, mature and discharge ova produces estrogen and progesterone V. Fallopian Tubes -10 cm long function: conveys ova to the uterus site for fertilization Segments: - infundibulum – 2cm funnel-shaped covered with fimbrae - ampulla – site for fertilization 5 months intrauterine – 5 – 7 million oocytes At birth – 2 Million oocytes Prepuberty / Childhood – 300,000 to 400,000 Puberty – 30,000 to 40,000 oocytes Reproductive age – 400,000 to 500,000 Menopause - Absent  MENSTRUATION Average cycle: 28 days (23-35 days) Duration: 4-6 days (normal) 1-9 days (abnormal) Normal blood loss: 30-80 cc  MENSTRUATION Organs involved: 1. hypothalamus GnRH –stimulates APG-release hormone 2, Anterior pituitary gland/ Gonadotropins : stimulates gonads adenohypophysis secretes estrogen and progesterone : FSH –maturation of primordial follicle : LH - ovulation 3. ovaries –releases eggs (ovum) 4. uterus - develops stratum functionalis in preparation for pregnancy  PHASES OF THE MENSTRUAL CYCLE 1. Proliferative/Follicular/Estrogenic/Post-menstrual Phase  Day 6-14  After the menstrual flow  Endometrium is thin  Increase level of estrogen- endometrium to proliferate – thickens eightfold  FSH -causes follicle to grow – GRAAFIAN FOLLICLE (mature) - PRIMORDIAL FOLLICLE (immature) Note: ONLY ONE FOLLICLE MATURE PER MENSTRUAL CYCLE  Ovulation – day 14; LUTEINIZING HORMONE – causes ovary to release egg  Peak in estrogen signals the next phase  PHASES OF THE MENSTRUAL CYCLE II. Luteal/ Secretory/ Progestational/ Pre-menstrual Phase  Day 15-28  Always 14 days in length  Production of CORPUS LUTEUM  Progestrone effect – maintains the uterus III. Ischemic Phase  No fertilization – CL regress after 8-10 days  Decrease production of estrogen & progesterone- causing endometrium to degenerate- few hours maximum of 1 day  Day 28 IV. Menstrual Phase  Low level of estrogen and progesterone  Passage of menstrual flow ABNORMALITIES OF MENSTRUATION: 1. AMENORRHEA = TEMPORARY ABSENCE OF MENSTRUAL FLOW 2. DYSMENORRHEA = PAINFUL MENSTRUATION 3. OLIGOMENORRHEA = MARKEDLY DIMINISHED MENSTRUATION 4. POLYMENORRHEA = TOO FREQUENT MENSTRUATION OCCURING AT INTERVALS OF LESS THAN THREE WEEKS 5. MENORRHAGIA = EXCESSIVE MENSTRUAL BLEEDING 6. METRORRHAGIA = BLEEDING BETWEEN PERIODS; INTERCYCLIC BLEEDING 7. HYPOMENORRHEA = ABNORMALLY SHORT MENSTRUATION 8. HYPERMENORRHEA = ABNORMALLY LONG MENSTRUATION  SIGNS OF OVULATION 1. MITTLESCMERZ = A CERTAIN DEGREE OF PAIN FELT AT THE LOWER LEFT OR RIGHT ILIAC 2. CERVICAL MUCUS METHOD OR BILLING’S METHOD = CHANGES IN CERVICAL MUCUS SECRETIONS TO CLEAR, ELASTIC & WATERY ( MOST RELIABLE SIGN). 3. SPINNBARKHEIT TEST = TEST FOR ELASTICITY OF CERVICAL MUCUS 4. INCREASE IN BASAL BODY TEMPERATURE 5. MOOD CHANGES 6. INCREASE LIBIDO 7. BREAST TENDERNESS/FULLNESS ZYGOTE:  IT CONTAINS 46 CHROMOSOMES: 44 AUTOSOME, XX, XY  JOURNEYS FROM THE FALLOPIAN TUBE TO THE UTERUS FOR 3-5 DAYS  16 HOURS AFTER FERTILIZATION, IT UNDERGOES ITS FIRST CELL DIVISION ,” BLASTOMERE”  MORULA – 16 or more blastomere  Blastocysts – reaches the uterus: - Blastocele –embryonic disc ; 3 germ layers : ectoderm, mesoderm, endoderm - Trophoblast – HCG  Implantation bleeding – rupture of the vessels and bleeding  after implantation -uterus is now termed as DECIDUA  TERMINOLOGIES  ZYGOTE - product of fertilization; < 2 weeks AOG  EMBRYO - intrauterine growth; 2 - 8weeks AOG  FETUS - 8 weeks to birth  VIABILITY - period fetus can be delivered and capable of living - 24 weeks and above  GRAVIDA- number of PG that reach age of viability regardless of outcome T – term ( 38-42 weeks) P – preterm ( 2000 ml) Oligohydramnios (< 500) ml indicate an abnormal process ABNORMAL AMNIOTIC COLORS: 1. GREEN TINGES OR MECONIUM STAINED – SIGNIFIES FETAL DISTRESS 2. GOLD OR YELLOW – SIGNIFIES HEMOLYTIC DISEASE SUCH AS Rh OR ABO INCOMPATIBILITY 3. GRAY – INDICATES INFECTION 4. PINK – SIGNIFIES BLEEDING  UMBILICAL CORD / FUNIS  CARRY O2 & NUTRIENTS FROM THE PLACENTA TO THE FETUS & RETURN THE UNOXYGENATED BLOOD & FETAL WASTE PRODUCTS TO THE PLACENTA.  50 -55 CMS LONG. APPEARS DULL WHITE,  COMPOSED OF 2 ARTERIES & 1 VEIN ( AVA)  IF ONLY TWO BLOOD VESSELS, SUSPECT RENAL ANOMALIES.  PLACENTA * FORMED FROM THE CHORIONIC VILLI AND DECIDUA BASALIS. * IT REACHES MATURITY AT 8 WEEKS FUNCTIONAL 12 weeks – 41-42 weeks DEGENERATE AFTER THE 42ND WEEK – DANGEROUS TO FETUS TO REMAIN IN UTERO BEYOND 42 WEEKS GESTATION.  FUNCTIONS OF THE PLACENTA 1. RESPIRATORY SYSTEM = EXCHANGE OF GASES TAKES PLACE IN THE PLACENTA, NOT IN THE FETAL LUNG. 2. RENAL SYSTEM = WASTE PRODUCTS ARE BEING EXCRETED THROUGH THE PLACENTA NOTE: IT IS THE MOTHER’S LIVER WHICH DETOXIFIES THE FETAL WASTE PRODUCTS 3. GASTROINTESTINAL SYSTEM = NUTRIENTS PASS TO THE FETUS VIA THE PLACENTA BY DIFFUSION THROUGH THE PLACENTAL TISSUES. 4. CIRCULATORY SYSTEM = FETO PLACENTAL CIRCULATION IS ESTABLISHED BY SELECTIVE OSMOSIS 5. PROTECTIVE BARRIER = INHIBITS PASSAGE OF CERTAIN BACTERIA & LARGE MOLECULES ** PROVIDES MATERNAL IMMUNOGLOBULIN G ( IG G) THAT GIVES FETUS PASSIVE IMMUNITY TO CERTAIN DISEASES FOR THE FIRST FEW MONTHS AFTER BIRTH. 6. ENDOCRINE SYSTEM = PRODUCES HORMONES HCG, HPL ( HUMAN PLACENTAL LACTOGEN “ CHORIONIC SOMATOTROPIN”, ESTROGEN , PROGESTERONE, RELAXIN  NORMAL FETAL DEVELOPMENT FIRST TRIMESTER 4 WEEKS FORM OF EMBRYONIC DISC, SPINAL CORD IS FORMED; RUDIMENTARY HEART APPEARS AS A PROMINENT BULGE ON THE ANTERIOR SURFACE, ARMS & LEGS BUD LIKE STRUCTURES, RUDIMENTARY EYES, EARS, & NOSE ARE DISCERNABLE 8 WEEKS ORGANOGENESIS IS COMPLETE, HEART BEATS RHYTHMICALLY, , FACIAL FEATURES ARE DISCERNABLE,EXTREMITIES HAVE DEVELOPED,, EXTERNAL GENITALIA PRESENT BUT NOT DISTINGUISHABLE PRIMITIVE TAIL IS REGRESSING, ABDOMEN APPEARS LARGE AS FETAL INTESTINES GROWS RAPIDLY,EYES MOVE FROM FACE TO FRONT SONOGRAM SHOWS GESTATIONAL SAC ( DIAGNOSTIC OF PREGNACY) 12 WEEKS NAIL BEDS FORMING ON FINGERS & TOES, BONE OSSIFICATION BEGINS, TOOTH BUDS PRESENT, SEX DISTINGUISHABLE BY OUTWARD APPEARANCE, KIDNEYS SECRETE, HEARTBEAT AUDIBLE BY A DOPPLER 16 WEEKS FETAL HEART SOUNDS AUDIBLE VIA FETOSCOPE, LANUGO IS WELL FORMED, LIVER & PANCREAS FUNCTIONING, FETUS SWALLOWS AMNIOTIC FLUID SHOWING AN INTACT BUT UNCOORDINATED SWALLOWING REFLEX, SEX CAN BE DETERMINED BY ULTRASOUND;QUICKENING FELT BY A MULTIGRAVIDA 20 WEEKS QUICKENING FELT BY A PRIMAGRAVIDA, ANTIBODY PRODUCTION IS POSSIBLE, HAIR FORMS INCLUDING EYEBROWS & HAIR ON HEAD, MECONIUM PRESENT IN UPPER INTESTINE, BROWN FAT ( AIDS IN TEMPERATURE REGULATION AT BIRTH) BEGINS TO BE FORMED BEHIND THE KIDNEYS, STERNUM, & POSTERIOR NECK, FETAL HEART AUDIBLE VIA STETHOSCOPE, VERNIX CASEOSA BEGINS TO FORM, 24 WEEKS PASSIVE ANTIBODY TRANSFER FROM MOTHER TO FETUS B BEGINS.INFANTS BORN BEFORE ANTIBODY. TRANSFER HAS TAKEN PLACE HAVE NO NATURAL IMMUNITY & NEED MORE THAN THE USUAL PROTECTION AGAINST INFECTIOUS DISEASE IN THE NEWBORN UNTIL THE INFANT’S OWN STORE OF IG’S CAN BUILD UP;  MECONIUM IS PRESENT IN THE RECTUM;  ACTIVE PRODUCTION OF LUNG SURFACTANT BEGINS; EYEBROWS & EYELASHES WELL DEFINED; EYELIDS NOW OPEN; PUPILS REACTIVE TO LIGHT; HEARS IN RESPONSE TO SUDDEN SOUND. 28 WEEKS LUNG ALVEOLI BEGINS TO MATURE; SURFACTANT PRESENT IN AMNIOTIC FLUID; TESTES BEGIN TO DESCEND 32 WEEKS SUBCUTANEOUS FAT BEGINS TO BE DEPOSITED FETUS IS AWARE OF SOUNDS OUTSIDE THE MOTHERS BODY; ACTIVE MORO REFLEX PRESENT, BIRTH POSITION( VERTEX OR BREECH) MAY BE ASSUMED; IRON STORES THAT PROVIDE IRON FOR THE TIME THAT THE NEONATE WILL INGEST ONLY MILK AFTER BIRTH ARE BEGINNING TO BE DEVELOPED; FINGERNAILS GROW TO REACH END OF FINGERTIPS. 36 WEEKS ADDITIONAL AMOUNTS OF SUBCATANEOUS FATS ARE DEPOSITED; SOLE OF THE FOOT HAS ONLY ONE OR TWO CRISSCROSS CREASES; LANUGO BEGINS TO DIMINISH; MOST BABIES TURN INTO A VERTEX OR HEAD-DOWN PRESENTATION DURING THIS MONTH 40 WEEKS FETUS KICKS ACTIVELY CAUSING DISCOMFORT TO THE MOTHER; VERNIX CASEOSA IS FULLY FORMED; ** IN PRIMIPARAS, THE FETUS OFTEN SINKS INTO THE BIRTH CANAL DURING THE LAST TWO WEEKS ( UP TO 4 WEEKS), GIVING THE MOTHER A FEELING THAT HER LOAD IS BEING LIGHTENED. THIS IS TERMED LIGHTENING. IT IS A FETAL ANNOUNCEMENT THAT THE THIRD TRIMESTER OF PREGNANCY HAS ENDED AND BIRTH IS AT HAND.**  PHYSIOLOGIC CHANGES DURING PREGNANCY CIRCULATORY / CARDIOVASCULAR: ** BEGINNING THE END OF THE FIRST TRIMESTER, - GRADUAL INCREASE OF ABOUT 30%-50% IN TOTAL CARDIAC VOLUME..” - PHYSIOLOGIC ANEMIA OF PREGNANCY ** PSEUDOANEMIA – AS THE BLOOD VOL. INCREASES, THE CONCENTRATION OF HGB MAY DECLINE MX: iron supplement CONSENQUENCES OF INCREASED CARDIAC VOLUME: ** EASY FATIGABILITY & SHORTNESS OF BREATH DUE TO INCREASED WORKLOAD OF THE HEART MX: REST ** SLIGHT HYPERTHOPHY OF THE HEART CAUSING IT TO BE DISPLACED TO THE LEFT ** SYSTOLIC MURMURS DUE TO LOWERED BLOOD VISCOSITY ** NOSEBLEEDS MAY OCCUR DUE TO MARKED CONGESTION OF THE NASOPHARYNX ** PALPITATIONS DUE TO INCREASED PRESSURE ON THE DIAGPHRAGM ** EDEMA OF LOWER EXTERMITIES OCCURS DUE TO POOR CIRCULATION RESULTING FROM PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS MX; > RAISE LEGS ABOVE HIP LEVEL > AVOID PROLONGED STANDING & SITTING NOTE: EDEMA OF THE LEG IS NOT A SIGN OF TOXEMIA. ** VARICOSITIES COULD OCCUR DUE TO PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS OF THE LEG MX: > DO NOT CROSS LEGS WHEN SITTING > WEAR SUPPORT HOSE TO PROMOTE VENOUS FLOW THUS PREVENTING STASIS IN THE LOWER EXTREMITIES > APPLY ELASTIC BANDAGE – START AT THE DISTAL END TOWARDS THE TRUNK TO AVOID CONGESTION & IMPAIRED CIRCULATION IN THE DISTAL PART > AVOID USE OF KNEE HIGH SOCKS ** VARICOSITIES OF THE VULVA & RECTUM MX: > SIDE LYING POSITION WITH HIPS ELEVATED ON PILLOWS > MODIFIED KNEE CHEST POSITION ** THERE IS INCREASED CIRCULATING FIBRINOGEN- FORMATION ( THROMBI) IMPLICATION: PREGNANT WOMEN SHOULD NOT BE MASSAGED SINCE BLOOD CLOTS CAN BE RELEASED & CAUSE THROMBOEMBOLISM. ** DURING DELIVERY, THE ALLOWABLE BLOOD LOSS IS 250- 450 ML (MAXIMUM 500 ML) FOR A SINGLE FETUS, 1000 ML FOR VAGINAL DELIVERY OF TWINS OR CESARIAN SECTION. ** SUPINE HYPOTENSION SYNDROME OR VENA CAVA SYNDROME = THE WEIGHT OF THE GRAVID UTERUS PRESSES ON THE VENA CAVA OBSTRUCTING BLOOD FLOW. THE WOMAN EXPERIENCES LIGHTHEADEDNESS, FAINTNESS & HEART PALPITATIONS. MX: LEFT SIDE LYING OR LEFT LATERAL SO AS NOT TO COMPRESS THE VENA CAVA. NO SUPINE POSITION AFTER 20 WEEKS AOG RESPIRATORY SYSTEM: ** SLIGHT DYSPNEA MAY OCCUR UNTIL LIGHTENING CAUSED BY INCREASED O2 CONSUMPTION & PRODUCTION OF CO2 GASTROINTESTINAL SYSTEM: ** MORNING SICKNESS MX: EAT DRY CRACKERS 30 MINUTES BEFORE ARISING IN THE MORNING. AVOID SPICY, FATTY FOODS HYPEREMESIS GRAVIDARUM = EXCESSIVE NAUSEA & VOMITING WHICH PERSISTS BEYOND 3 MONTHS THAT COULD RESULT TO DEHYDRATION, STARVATION, MALNUTRITION AND F & E IMBALANCE MX: D10NSS 3000 ML IN 24 HOURS IS THE PRIORITY OF TREATMENT > REST > ANTI- EMETICS (EX. PLASIL) CONSTIPATION = DUE TO DISPLACEMENT OF THE STOMACH & INTESTINES AND DUE TO INCREASED PROGESTERONE DURING PREGNANCY ( DECREASED PERISTALSIS) MX: > INCREASE FLUID INTAKE > HI - FIBER DIET ESTABLISH REGULAR ELIMINATION PATTERN EXERCISE > MINERAL OIL SHOULD NOT BE USED BECAUSE IT INTERFERES WITH ABSORPTION OF FAT SOLUBLE VITAMINS ( ADEK) HEARTBURN = REFLUX OF STOMACH CONTENT INTO THE ESOPHAGUS DUE TO INCREASED PROGESTERONE WHICH DECREASES GASTRIC MOTILITY MX: > PATS OF BUTTER BEFORE MEALS > AVOID FRIED, FATTY FOODS > BEND AT THE KNEES NOT AT THE WAIST > TAKE ANTACIDS EX. MILK OF MAGNESIA BUT NEVER SODIUM NHCO3 ( ALKA SELTZER OR BAKING SODA) BECAUSE IT PROMOTES FLUID RETENTION. PICA = **ABNORMAL CRAVING FOR NON NUTRITIOUS SUBSTANCES. THE MOST COMMON IS CRAVING FOR ICE CUBES. THERE COULD ALSO BE CRAVING FOR PAPER, ETC., **OFTEN ACCOMPANIES IRON DEFICIENCY ANEMIA **ENCOURAGE TO TAKE IRON SUPPLEMENTS MUSCULOSKELETAL SYSTEM GRADUAL SOFTENING OF PELVIC LIGAMENTS AND JOINTS TO FACILITATE PASSAGE OF THE BABY. LORDOSIS= FORWARD CURVATURE OF THE LUMBER SPINE. “THE PRIDE OF PREGNANCY” LEG CRAMPS - IMBALANCE OF CALCIUM PHOSPHORUS RATIO IN THE BODY AND FROM PRESSURE OF THE UTERUS ON LOWER EXTREMITIES; LOW CALCIUM AND HIGH PHOSPHOROUS INTAKE MANAGEMENT: **FREQUENT REST PERIODS WITH FEET ELEVATED **WEAR WARM, COMFORTABLE CLOTHING **INCREASE CALCIUM INTAKE (CALCIUM TABLETS AND DIET) **DO NOT MASSAGE= BLOOD CLOTS CAN CAUSE EMBOLISM **MOST EFFECTIVE RELIEF: PRESS KNEE OF THE AFFECTED LEG AND DORSIFLEX THE FOOT. Urinary System-its changes result from: - effects of estrogen and progesterone - compression of the bladder and ureters - increased blood volume - postural influences a. Urinary frequency b. Increased susceptibility to UTI c. Urinary stasis d. Traces of albumin in the urine e. Stress incontinence  Temperature-slightly increased though at about 16th weeks it generally decreases to normal * Integumentary System a. Diaphoresis b. Palmar erythema c. Vascular spiders d. Hyperpigmentation *linea nigra *melasma/chloasma/mask of pregnancy *striae gravidarum e. Diastasis recti-separation of the rectus abdominus muscles  EMOTIONAL RESPONSES: A. First trimester = ambivalence, rejection, denial, disbelief, repression Implication: when giving health teachings, be sure to emphasize the bodily changes in pregnancy. B. Second trimester = fetus is perceived as a separate entity. Fantasizes appearance of the baby ( 4-6 months) C. Third trimester = Best time to talk about preparation of layatte & infant feeding method. Fear of death is imminent ( to allay fears , let pregnant woman listen to fetal heart tones.  THE PSYCHOLOGICAL TASKS OF PREGNANCY: A.FIRST TRIMESTER = ACCEPTING THE PREGNACY = Acceptance of reality & incorporation of fetus into body image B. SECOND TRIMESTER = ACCEPTING THE BABY = preparation from physical separation from fetus C. THIRD TRIMESTER = PREPARING FOR THE DELIVERY & PARENTHOOD = Attainment of maternal role PATERNAL REACTIONS TO PREGNANCY: A. FIRST TRIMESTER = Ambivalence & anxiety about role change; concern for identification with mother’s discomforts ( couvade syndrome) B. SECOND TRIMESTER = Increased confidence & interest in mother’s care; difficulty relating to fetus; “JEALOUSY” C. THIRD TRIMESTER = Changing self concept; concern about body changes; SIBLING REACTIONS TO PREGNANCY: A.Normal rivalry dependent on developmental stage B. May need increased affection & attention  DANGER SIGNS OF PREGNANCY 1.VAGINAL BLEEDING 2. PERSISTENT VOMITING ( HYPEREMESIS GRAVIDARUM) = nausea & vomiting that continues past the 12 week of pregnancy. 3. CHILLS & FEVER 4. SUDDEN ESCAPE OF FLUID FROM THE VAGINA 5. ABSENCE OF FETAL HEART SOUNDS AFTER THEY HAVE INITIALLY BEEN AUSCULTATED 6. SWELLING OF THE FACE & FINGERS = EDEMA. 7. ABDOMINAL OR CHEST PAINS 8. FLASHES OF LIGHTS; BLURRING OF VISION; SEVERE HEADACHE & DIZZINESS 9. SUDDEN CHANGES IN THE CHARACTER AND FREQUENCY OF FETAL MOVEMENT MINOR DISCOMFORTS OF PREGNANCY A.NAUSEA AND VOMITING Management/Measures: 1. Eating dry crackers before arising from bed 2. Eating small, frequent, low fat meals during the day 3. Drinking liquids between meals 4. Avoiding fried foods 5. Avoiding all anti-emetics throughout pregnancy B. SYNCOPE/FAINTNESS Management/Measures: 1. Sitting with feet elevated 2. Changing positions slowly 3. Changing the position to the left side to relieve the pressure of the uterus on the inferior vena cava C. Urinary Urgency & Frequency Management/Measures: 1. Limiting fluid intake in the evening 2. Voiding at regular intervals 3. Sleeping on the side at night 4. Wearing of perineal pads if necessary (stress incontinence) D. Breast Tenderness Management/Measures: 1. Encourage the use of supportive bra with non-elastic straps 2. Avoiding the use of soap on the nipples and areola area to prevent drying E. Increased Vaginal Discharge Management/Measures: 1. Proper cleansing and hygiene 2. Wearing of cotton underwear 3. Avoiding douching 4. If infection is suspected consult HCP 5. Wear perineal pad 6. Do not use tampon F. Nasal Stuffiness Management/Measures: 1. Encourage the use of humidifier 2. Avoiding the use of nasal sprays or antihistamines G. Fatigue Management/Measures: 1. Arranging frequent rest periods throughout the day 2. Obtaining regular exercises 3. Avoid eating and drinking foods containing stimulants throughout pregnancy H. Heartburn/Pyrosis/Gastric Acid Reflux Management/Measures: 1. Eating small frequent meals 2. Sitting upright for 30 mins. following a meal 3. Drinking milk/fluid between meals 4. Avoiding fatty and spicy foods 5. Avoiding antacids I. Ankle Edema Management/Measures: 1. elevating the legs at least twice a day 2. Sleeping on the left side 3. Wearing supportive stockings 4. Avoid sitting/standing in one position for long periods of time 5. Avoid using diuretics during pregnancy J. Varicose Veins Management/Measures: 1. wearing support hose 2. Elevating the feet when sitting 3. Lying with the feet and hips elevated 4. Moving about while standing to improve circulation 5. Avoid pressure on the lower thighs 6. Avoid leg crossing 7. Avoid long period of sitting/standing 8. Avoid use of constricting clothing 9. Increase Vit. C K. Headache Management/Measures: 1. Changing position slowly 2. Applying a cool cloth to the forehead 3. Eating a small sweet snack 4. Using medications as prescribed L. Hemorrhoids Management/Measures: 1. Soaking in a warm sitz bath 2. Sitting in a soft pillow 3. Eating high fiber foods 4. Drinking sufficient fluid 5. Increasing exercise 6. Applying ointments as prescribed M. Constipation Management/Measures: 1. Eating high fiber foods 2. Drinking plenty of water/fluids 3. Exercise regularly Avoid mineral oil/laxatives Avoid OTC and herbal drugs Avoid enemas N. Backache Management/Measures: 1. Encourage rest 2. Use good body mechanics and posture 3. Wearing of low-heeled shoes 4. Perform pelvic exercises 5. Sleep in a firm mattress O. Leg Cramps Management/Measures: 1. Getting regular exercise especially walking 2. Elevating the feet and dorsiflexion of the toes when resting 3. Increasing calcium intake P. Shortness of Breath Management/Measures: 1. Allowing frequent rest periods 2. Sleeping with the head elevated or in side lying position 3. Avoid overexertion Q. Heart Palpitations Management/Measure: 1. Gradual, slow movements R. Palmar Erythema/Pruritus Management/Measure: 1. Calamine lotion C. Exercises Advantages: 1. Strengthen the muscles to promote their quick return to normal condition after childbirth 2. Promote circulation, prevent and relieve problems like varicosities and hemorrhoids 3. Relieve tension and anxiety 4. Improve posture and appearance 5. Improve metabolic efficiency Recommended exercises during pregnancy: 1. Pelvic rocking (5 times a day) 2. Squatting/tailor sitting (15 minutes/day) 3. Rib cage lifting 4. Calf stretching 5. Shoulder circling 6. Abdominal muscle contractions 7. Modified knee chest 8. Leg elevation 9. Leg raising 10. Panting 11. Kegel’s exercise PRENATAL CARE PRENATAL CLINIC 1. History of client - menarch, LMP, EDC, OB scoring 2. Take BP – Sitting: slightly higher Supine: intermediate reading Left lateral: lowest reading 3. Abdominal Assessment - Position: supine with both legs flexed Inspection: striae, linea nigra Take fundic height – estimates AOG 4. Perform Leopold’s maneuver  1. Let woman void 2. Position in supine with knees flexed with small towel on one side 3. Wash hands and warm hands 1. 1st maneuver : head- firm, round. Movable : breech – less- well defines 2nd Maneuver – back – smooth, soft, hard not engaged – movable 4th maneuver: fetal attitude a. Occiput/vertex b. Sinciput. Military c. Brow d. face 5. Antenatal visit 0-28 weeks AOG monthly 28- 36 weeks AOG every 2 weeks 36 weeks onwards every week DRUGS THAT SHOULD NOT BE TAKEN 1. NSAID (Indomethacin)  cause premature closure of the Ductus Arteriosus No supply the lower half of the body of the fetus Causes oligohydramios Neonate complications – pulmonary HPN, necrotizing enterocolitis, intracranial hemorrhage, cystic brain lesion, renal dysfunction DRUGS THAT SHOULD NOT BE TAKEN II. Aspirin  hemorrhage Premature closure of ductus arteriosus Pulmonary hypertension Prolonged gestation and labor Intrauterine growth restriction Congenital salicylate intoxication DIAGNOSTIC EXAMINATION 1. Amniocentesis – 14-16 weeks 2. Ultrasound - transabdominal – full bladder 1 hr before procedure - transvaginal - client void 3. Biophysical Score (ultrasound and CTG) - fetal reactivity - fetal breathing movement - fetal tone - amniotic fluid volume - fetal heart activity Fetal Score of 8-10 well fetus 6 suspicious 4 jeopardy DIAGNOSTIC EXAMINATION 4. Non-stress Test - measures response of fetal heart rate in relation to fetal movements - uses cardiotograph (CTG) tracing Reactive – normal; 2 or more accelerations of fetal heart beat of 15 beats/ min lasting for 15 seconds Non reactive – no accelerations DIAGNOSTIC EXAMINATION 5. Contraction -stress Test - measures response of fetal heart rate in relation to uterine contraction - best done – 38 weeks AOG a. Nipple stimulation b. Oxytocin challenge test Findings: Negative (normal)- no late decelerations Positive (abnormal) late decelearations DIAGNOSTIC EXAMINATION 6. Chorionic villi sampling – analysis of chorionic villi from the placenta for DNA analysis - done at 8-10 weeks Post procedure: instruct report of chills or fever 7. alpha-fetoprotein – glycoprotein produced by the liver, peak in maternal serum at13-32 weeks of PG normal value – 10-150ng/ml elevated - neural tube defect decrease- chromosomal disorder