OB DAY 1.docx

Maternal Nursing (NP2) (care for the mother and child) +-----------------------+-----------------------+-----------------------+ | Pregnancy | Labor / Delivery | Postpartum | | | | | |...

Maternal Nursing (NP2) (care for the mother and child) +-----------------------+-----------------------+-----------------------+ | Pregnancy | Labor / Delivery | Postpartum | | | | | | | Delivery of Fetus and | | | | Placenta | | +=======================+=======================+=======================+ | Average: 40 weeks | Stage I: Cervix | 6 weeks | | | Dilation (through | | | Acceptable range: | uterine contractions) | Return of Uterus and | | 38-42 weeks | | Vagina | | | (10cm) | | | Below 20 weeks: | | Pre-Pregnancy State | | Without survival | Latent: 0-3 cm (mild) | | | | | (INVOLUTION) | | Greater than 20 | Longest | | | weeks: Fetus can live | | Vs. SUBINVOLUTION | | | Primi = 8-20 hours | | | Maximum: 42 Weeks | | | | | Multi = 5-15 hours | | | Greater than 42 | | | | Weeks: Fetal Death | Active: 4-7 cm | | | | (Moderate) | | | 9 Calendar months: | | | | Used when talking to | Primi = 1cm/hr | | | the patient | | | | | Multi = 1.5 cm/hr | | | 1 month = 4 weeks (10 | | | | Lunar Months) | Transitional: 8-10 | | | | cm(Strong) | | | | | | | | Bear Down during | | | | contraction | | | | | | | | Stage II: Fetal | | | | Delivery | | | | | | | | Primi= 1-2 hours | | | | | | | | Multi = 30 min -- 1 | | | | hour | | | | | | | | Stage III: Placental | | | | Delivery | | | | | | | | Primi/Multi = 5-15 | | | | min | | | | | | | | Max: 30 min | | | | | | | | Report: If the | | | | delivery is longer | | | | | | | | Stage IV: Recovery of | | | | the patient | | | | | | | | 1^st^ 4 hours after | | | | Delivery | | | | | | | | Monitoring = | | | | Hemorrhage | | | | | | | | NSD \> 500ml/24 hours | | +-----------------------+-----------------------+-----------------------+ Pregnancy Sex Organs (Gonads) Sex Hormones Female: Egg Cell / Ovum Ovaries Estrogen prepares Uterus and Breasts Male: Sperm Testis Testosterone Ovarian Cycle ALAMAT NG REGLA NI NENE Bata pa [ESTROGEN] is [LOW] (Adrenal Gland) [PUBERTY] (9-16) dapat [UP] to go With the bit of right hormones [Hypothalamus] release [GnRH] Gonadotropin Releasing Hormone (Sex organs Growth) (Ovaries) [Anterior Pituitary Gland] release [FSH] (Follicle Stimulating Hormone) [Primordial (Primary)] young, but FSH's high Add some more stimulation, turns to [Graafian] [(Have] follicular fluid that are rich in estrogen) Then [ESTROGEN] will surge Proliferate endometrial Cells for IMPLANTATION [Proliferation] phase or Estrogenic Phase or Follicular Phase Part 2 (Only moves on when estrogen is high) APG now produce [LH] (Luteinizing) (Goal: para lumabas ang Lutein) An egg embarks (Leave) - [Ovulation "Fertility"] (The left follicle is corpus luteum (Lutein) High in Progesterone with Low Estrogen Luteal Phase / Progesteronic Phase/ Secretory Phase Follicles become YELLOW, that's [Corpus Luteum] (waits 8 to 10 days) HCG Chorion Placenta (2^nd^ Trimester) Corpus Albicans (if fertilization didn't occur) Decreases Estrogen and Progesterone Contains [Progesterone] (Hormone of Pregnancy) and little Estrogen (Female Hormone) Progesterone 1. Keeps the lining intact, 2. Lining Thicker, 3. Secretions Thicker 4. Relax uterus Egg cell waits for 2 days in the Ampulla and Sperm can live up to 3 to 5 days in the uterus Pag di na fertilize Ischemic Phase (3 days) Discharge lining, mucus, egg, blood (30-80 ml) (Menstrual Phase) Average: 3-5 Days Range 2-9 Days 1^st^ Mens = Menarche 9-16 years old Fertilization Ovulation = 14 days from the next menstruation Cycle Average = 28 Days Range = 23-35 Days Day 1 1^st^ day of menstruation Day 1 1^st^ day of menstruation Irregular: Monitor for 3-6 months Shortest Cycle = 23 -18 Longest Cycle = 38 -- 11 Fertile day: 5th to 27th Day 1: 1^st^ day menstruation Ovum: Egg cell Zygote: egg + sperm (Fertilization) Morulla: Mitosis Embryo: Implant = 5-8 weeks Fetus: Organogenesis complete (8^th^ weeks) Fetal Development (average 40 weeks 10 Lunar Weeks) 3 Trimesters 1^st^ Trimester (x4 weeks) 12-14 weeks Most Delicate First Lunar Month (4 weeks) Four weeks old Implanted 50% Embryo "Embed" Rudimentary heart Spinal Cord fusion CNS: first developing organ as early as 3^rd^ week (Neural Tube Defect) (Folic Acid) Three Germ Layers (EME) +-----------------------+-----------------------+-----------------------+ | Ectoderm (outside) | Mesoderm (Middle) | Endoderm (inside) | +=======================+=======================+=======================+ | Eyes, Ears, Nose | Muscles, muscular | Lower urinary tract | | | system | | | CNS | | Linings | | | Enamel of the Teeth | | | Touch (integumentary) | | Lalamunang may TT.TT | | and Taste | Skeletal | | | | | Throat, tonsils, | | Openings (mouth | Organs | thyroid, thymus, | | rectum) | | trachea | | | Circulatory | | | | | Lungs | | | Upper Urinary | | | | | | | | Reproductive | | +-----------------------+-----------------------+-----------------------+ Second Lunar Months (8 Weeks) Sac (Gestational Sac, Amniotic Sac) (Contains Fetus + Fluid) (4-6 weeks) Probable Sign Extremities Contraction of heart (seen in the ultrasound) Organogenesis is now completed (FETUS) Noticeable Face Digestive System: Swallow Amniotic Fluid Third Lunar Months (12 Weeks) Tooth buds / bone ossification Heard the heart sound Ihi formation (Amniotic Fluid = small) (Amniotic Fluid = Maternal Fluid) Sampling: Chorionic Villi Sampling (CVS) (Consent) (Empty Bladder) (Ultrasound machine bedside) Reflex (Babinski) Stroking of the talampakan (Fanning of the toes) (Positive) (until birthday) Doppler for the fetal heart rate Second Trimester 4^th^, 5^th^, 6^th^ months Fourth Lunar Months (16^th^ weeks) Fetoscope / Fine downy hair (Lanugo) (Malalagas in 36 weeks) Ordinary Stethoscope (5 months) Urinates (Increase in Amniotic Fluid) (Amniocentesis = 20ml) Reveal sex/gender (16^th^ weeks) Five Lunar Months (20 Weeks) (5 to 10% survival rate) Fetal movements felt Quickening (Primi = 18-20 weeks) (Multi = 16 weeks) IgG (Gravidity, Gestation) (Antibodies) Vernix Caseosa -- White Cheese like susbstance in the skin PURPOSE = Protection and Heat. Term: Scarce Vernix, Post Term: + Desquamation Six Months "The Special" Scalp hair / eye lash and eye brow Sound (Most soothing sound is maternal voice) SURFACTANT -- Produced by lungs (prevents alveolar collapse) (Expiration) Surfactant is Complete in 38 weeks (Term) Survival: Age of Viability (AOV) 20-24 weeks Lack of Surfactant respiratory distress syndrome (RDS) 500g weight Third Trimester 7^th^, 8^th^,9^th^ 10^th^ Months Seven Lunar Months 28^th^ Weeks Scrotum Cryptorchidism (Undescended Testes) Testicular Cancer Eyes Delicate Vessels in retina forming = High oxygen concentration is monitored to prevent blindness Eye Blinking peaks Ninety percent Survival Eight Lunar Months 32^nd^ Weeks Extends when startled: Moro Brachial Plexus injury Iron stores in liver (used up to 6 months of life) Grows Faster (term = 50 cm) (Preterm: Old Man's Face) Hermit -- face is now gone Tips of nails = Fingertips Ninth Lunar Month 36^th^ Weeks Near Term Increased fats Nearly 100% Survival Turn Around Head Down: Cephalic Presentation Ten Lunar Months 40 weeks Term = (38-42 weeks) Best = (39-40 weeks) Engagement = Descend of fetus entering pelvic inlet Mother: Lightening (Bumaba na yung bata) Nearing birth Deadline: 42 weeks \>42 weeks = Post term 1\. Cord Compression (o2, blood) 2\. Difficult delivery 3\. Decrease in Amniotic Fluid and Diminishing Placental Functioning Normal Pregnancy Maternal Physiologic Changes Signs of Pregnancy Presumptive (Subjective) (Sumbong) (Complains, Feelings, Experiences) Pains: Legs, Back, Chest, Head **Pain the the Legs** Normal: Cramps Causes: Low Calcium, High Phosphate Prevent: Calcium 1g/day, Magnesium citrate/lactate BID Management: Dorsiflex Foot, Extend the knee Abnormal: Clot due to heavy uterus makes the blood in the veins harder to go up Cause: Uterine Pressure Prevent: Good Circulation 1. Ambulate 2. Elevate 3. Hydrate 4. Elastic stockings (Before getting out of bed) (Pantyhose) Assess: Thrombophlebitis (pain, red, swelling, warm, fever) Management: Dorsiflex and Knees Extended + HOMAN SIGN (pain in calf muscle) Avoid: HAM (Don't use Hot compress, use moist heat / Do not ambulate / Do not massage) Bed: Call MD Doppler Ultrasound Drug: Anticoagulant: Heparin / No Warfarin Fetal Kidney Damage Embolectomy **Pain in the back** Normal Lower Back Pain Lordosis (Pride of Pregnancy) Cause: "P-R" Hormone (Progesterone, Relaxin) = Relaxes Pelvic Joints Encourage 4S: - Stand straight - Support Pillow in the back - Squatting - Shoes: Low Exercise: "P-R" - Pelvic Rock (Hollow the back for 1 Min) **Pain in the Chest** Normal: Burning / Heartburn/ Pyrosis: Increase in HCL acid = Flatulence Causes: Progesterone and Relaxin Sphincter relaxed (decreased motility of g.i tract (constipation) Stomach pushed upward (Enlarged uterus) Management: Small Frequent Feedings Slow chewing Should wait 2-3 hours (gastric emptying) Side: Left Support pillow: 2 Avoid: (ABTFC) Alka-Seltzer Baking soda (sodium bicarb) Tomato products (Juice, Paste) Fatty (Long digestion Citrus / Cabbage / Potato / Caffeine / Cassava / Cola Rx: Mahal Magnesium Hydroxide Histamine 2 receptor Blockers -- (Tidine) Aluminum Hydroxide (ex. Maalox) **Pain in the head** Normal Mild / Occasional Management Paracetamol Abnormal (Hypertention) Severe / Continues Unrelieved by paracetamol = Report \+ Visual Changes / Blurring (Report) **Respiratory Changes** S -- Stuffiness of nose Causes: Estrogen S -- Shortness of Breath 3^rd^ Trimester Causes: Enlarged Uterus Engaged = Lightening S -- Speedy breaths (RR:18-22) Causes: Enlarged Uterus **Enlarged Breasts** B -- Blue veins (Increase in Vascularity = Estrogen) R -- Readies Lactation: Progesterone, Human Placental Lactogen (HPL) (Human chorionic somatomammotropin) E -- Enlarged Breast = Estrogen A -- Areola Darkens = Estrogen S -- Secretes Colostrum (16 weeks\>IgA) Produce: Prolactin, Out: Oxytocin T- Tenderness and Tinggling Sensation: Estrogen **Skin Changes** (Fades after delivery) S -- Straia Gravidarum (Stretch marks) Management: Cocoa Butter Lotion reduces irritation S- Spider Veins / Diastasis Recti (Separation of abdominus rectus muscle) K -- Kloasma / Chloasma / Melasma (mask of pregnancy) I -- Increased in Pigmentation: Estrogen N -- Nigra (Linia) Dark thin line mid - abdomen **Urinary Frequency Cause** I -- Increased Bladder Pressure Mild -- 1^st^ tri / Fades -2^nd^ tri / Strong -- 3^rd^ Tri H -- Hormones HCG (1^st^ trimester) / Increase in Fluid Retention (Aldosterone) keeps sodium and water I -- Increased GFR: Glucose +1 **Movements** Felt by: Mother Called: Quickening When: 20 weeks Peak: 3^rd^ Tri (28-38 weeks) Assessment: Kick out (for High risk) Frequency: Once a day (OD) Position: Left recumbent (Best circulation) Time: One hour / Post Meal Rate: 10 -- 12 / hr If Abnormal: Ambulate then repeat if still less than 10 Report No: Supine Vena Cava Syndrome Supine Hypotension Right Hepatic Vein **Morning Sickness** (Nausea and Vomiting in the Pregnancy) (All Day) Peaks upon waking up Cause: "P-H-E-G" Continuously high Progesterone, Estrogen, HCG Low Glucose (organogenesis) upon waking up S -- Snack before bed, Small Frequent feeding, Sour ball candies, Sips of Carbonated beverage A -- Acupressure band (wrist), Acupuncture, Avoid 4s spicy, seasoned, sebo (fatty), sudden movements D -- Dry toast or crackers Glucose Small content of baking soda that can help for acidity upon waking up (Don't give water) Delay breakfast Doctor: \>2x a day vomits, \>1^st^ Tri, Signs of Dehydration (Hyperemesis Gravidarum) **Menses Cessation (Amenorrhea)** Cause: Increase Estrogen Return: Non -- Breastfeeding = 6 weeks to 10 weeks Breastfeeding = 3-4 months or more Lactational Amenorrhea as contraceptives 1\. Pure breastmilk 2\. Never Menstruated yet 3\. 6 Months Max **Palmar Erythema** What: Palm of hands Redness and Itchiness Cause: Estrogen Management: Calamine Lotion **\ ** **Tiredness** 1^st^ Trimester -- Low Glucose (Organogenesis) (Morning Sickness) 2^nd^ Trimester -- Increased Blood Volume Peak 1^st^ to increase: Plasma Seems Low: Red Blood Cell (Physiologic Anemia) Pseudo Anemia Kidney produces erythropoietin 3^rd^ Trimester -- Heaviest Pregnancy Deprived sleep due to increase in fetal movements and urinary frequency and shortness of breath R -- Relaxation / Recommend Dietary Allowance: + 300 Calorie/Day E -- Enough Sleep S -- Short Naps during day T -- Take FE + FA Take: Ferrous Sulfate: Iron total: 800mg 500mg: Mother / 300mg: Fetus Foods: Meats, Greens, Nuts/Grains If vegetarian: Lack of Vitamin B12 Pernicious Anemia Supplement 27mg (15-30mg) Side effects 1\. Increased G.I upset: Take w/ meal with vitamin c to increase absorption and avoid calcium and magnesium -- 2hours gap) 2\. Constipation: Increase fiber, Fluid and Mobilization Rx: Stool Softener (COLACE) (Docusate Sodium) Avoid = Laxative, Enema, Mineral oil Can cause preterm labor 3\. Stool Color: Greenish, Dark or Blackish (Normal Side effect Folic Acid (Vitamin B9) 400mcg/day Prevent Neural Tube Defect and Prevent Anemia Weight: Gain Total: 25-35 lbs 1^st^ Tri = 1kg Total / 1lb per month 2^nd^ to 3^rd^ Tri = 1lb per week Extra 2^nd^ Tri Up to: 2lbs / week **Increased Salivation** Called: Ptyalism Cause: Estrogen Cravings weird/ Abnormal: PICA Cause: Psychological issues or Low in Iron and Zinc Concern: 1\. Nutrition deficiency 2\. Can be harmful to fetus **Vaginal changes** Increase Secretion Cause: Estrogen Called: Leukorrhea White Management: Prevent infection 1^st^ Trimester (Anomalies for the fetus, Abortion) 2^nd^ to 3^rd^ Trimester: Preterm Labor Labor/ Delivery: Cesarian Section - Opthalmia neonatorum Blindness - Group B -- Beta hemolytic -- Death Promote: Good Perineal Hygiene (Front to Back) Cotton / Clean underwear Pads (Don't Use Tampon) Itapon ang tampon **Varicosed Veins** Blood pooling Distended Veins Cause: Uterine Pressure Management: "VEINS" V- Vitamins C, A, B = Healthy Blood Vessels E -- Elevate the Legs I -- Increase Circulation mobilization N -- No cross legs and constrictive knee heights S -- Sims position to relieve uterine pressure **Hemorrhoids:** Remember "CoCo Milk" Co -- Constipation management Co -- Cold Compress M -- Modified Sim's I -- Insert gently using fingers L -- Lotion = Witch Hazel K -- Knee Chest position (15-20 min a day) **Enlargement of Uterus/ Abdomen** Best assessment: LMP (1^st^ day of Last menstruation) Naegel's Rule 1\. Jan to March: +9 +7 2\. April to Dec: -3 +7 + 1 Mcdonald's Rule Measuring tape 1cm = 1 week Bartholomew Landmark Symphysis Pubis 3 months or 12 weeks Umbilicus 5 months or 20-22 weeks Xyphoid 9 months or 36 weeks