Ticzon Reviewer PDF

MCN Lec The primary goal of both maternal and child health nursing is the promotion and maintenance of optimal family health. Examples of the scope of practice include: Preconception healthcare Care of women during three trimesters of pregnancy and the puerperium (the 6 weeks after childbirt...

MCN Lec The primary goal of both maternal and child health nursing is the promotion and maintenance of optimal family health. Examples of the scope of practice include: Preconception healthcare Care of women during three trimesters of pregnancy and the puerperium (the 6 weeks after childbirth, sometimes termed the fourth trimester of pregnancy) Care of infants during the perinatal period (the time span beginning at 20 weeks of pregnancy to 4 weeks (28 days] after birth Care of children from birth through late adolescent Care in a variety of hospital and home care settings. family-centered approach- is the preferred focus of nursing care. The health of an individual and his or her ability to function as a member of a family can strongly influence and improve overall family functioning. Family-centered care enables nurses to better understand individuals and their effect It includes encouraging rooming-in with the mother Nurses provide guidance and monitor the interaction between family members to promote the health and well-being of the family FAMILY "a householder and one or more other people living in the same household who are related by birth, marriage, or adoption." - U.S. Census Bureau (2015) two or more people who live in the same household [usually], share a common emotional bond, and perform certain interrelated social tasks." - Rector and Stanley(2021) BASIC FAMILY TYPES Family of orientation - the family one is born into; oneself, parents, and siblings, if any. Family of procreation - a family one establishes; oneself, spouse or significant other, and children, if any. The Child-Free or Childless Family- Is composed of two people living together without children. The Cohabitation Family- are composed of couples, perhaps with children, who live together but remain unmarried. The Nuclear Family- The traditional nuclear family is composed of two parents and a child or children. In the past, it was the most common family structure seen worldwide. Binuclear family- is a family created by divorce when the child is raised in two families. The Extended (Multigenerational) Family- An extended or multigenerational family includes not only a nuclear family but also other family members such as grandmothers, grandfathers, aunts, uncles, cousins, and grandchildren. The Single-Parent Family- Single parents have difficulty working full time plus taking total care of young children. The Blended Family- (a remarriage or reconstituted family), a divorced or widowed person with children marries someone who also has children. The LGBTQ+ Family- Lesbian, gay, bisexual, transgender, queer, and other identity (LGBTQ+) people live together as partners for companionship. The Foster Family- Children whose parents can no longer care for them may be placed in a foster or substitute home by a child protection agency through the age of 17.  The Adoptive Family- Adoption can also offer a number of challenges for both the adopting parents and the child as well as for any other children in the family. Developmental Stages: Marriage (stage 1): Establish a mutually satisfying relationship. Learn to relate well to their families of orientation. Engage in reproductive life planning, if desired. The early childbearing family (stage 2): Integrate the new member into the family. Make whatever financial and social adjustments are necessary to meet the needs of the new member while continuing to meet the needs of the parents. The family with a preschool child (stage 3): Prevent unintentional Injuries (accidents) such as poisoning or falls. Begin socialization through play dates, childcare, or nursery school settings. The family with a school-aged child (stage 4): Promote children's health through immunizations dental care, and routine health assessments. Promote child safety related to home and automobiles. Encourage socialization experiences outside the home such as sports participation, music lessons, or hobby activities. Encouraging a meaningful school experience to make learning a lifetime concern, not one of more than 12 years. The family with an adolescent (oldest child is between 13 and 20 years of age) (stage 5): Loosen ties enough to allow an adolescent more freedom while still remaining safe Begin to prepare adolescents for life on their own The launching stage family: the family with a late adolescent (stage 6): Change the role from parents to once-removed support persons or guideposts Encourage independent thinking and adult-level decision skills in their child The family of middle-aged parents (stage 7): Adjust to "empty nest" syndrome by reawakening their relationship with their support partner Prepare for retirement so when they reach that stage they will not be unprepared socially or financially. The family in retirement or older age (stage 8): Maintain health by preventive care in light of aging. Participate in social, political, and neighborhood activities to keep active and enjoy this stage of life Responsible Parenthood- involves parents making informed decisions about family size and birth spacing based on their health, financial, and social circumstances. Responsible Parenting- helps children develop morality and life skills through supportive family relationships. A. UNITIVE( iisa na)( natural sexual relationship)  It is not a simple physical union It is a specific type of physical union of a man and woman in natural intercourse. The act must be open to life and towards procreation The unitive meaning is only found in natural intercourse between a man and a woman Therefore, all other types of sexual acts are non-unitive Example: Surrogate- also known as a gestational carrier, is a woman who carries and gives birth to a child for another person or couple. B. PROCREATIVE Is found only in natural intercourse. Even if each natural sexual act does not produce new life. New life is necessary in order to have a good moral object of the procreative meaning. Creation of a new human person by the act of sexual intercourse by a man and a woman. SEXUAL RELATIONSHIP IN MARRIAGE HAS TWO PURPOSES 1. Strengthen the couple and allow them to express their love in a powerful way (unitive) 2. Leads to the creation of new life (procreation) Situations: A woman and man who is not married but has a sexual intercourse is NOT unitive or procreative A woman and man are married and have sexual intercourse but do other sexual acts in procreating offspring, it is also not unitive or procreative Surrogate is NOT unitive and procreative  No condoms as well in unitive and procreative It must only be the natural act to be considered unitive and procreative Physiologic changes of pregnant patient ambivalence, frequent mood changes, varying from anxiety, fatigue, exhaustion, sleepiness, depressive reactions to excitement, nausea, vomiting namamaga ang breast ni mother dahil sa production ng milk( pain) as nurse dapat maalam sumagot ng tama sa patient. FOR PROMOTION OF REPRODUCTIVE AND SEXUAL HEALTH ASSESSMENT Problems of sexual or reproductive health may not be evident on first meeting with patients because it may be difficult for people to bring up the topic until they feel more secure with your relationship. This makes good follow-through and planning important because even if people find the courage to discuss a problem once, they may be unable to do so again. If the problem is ignored or forgotten through a change in caregivers, the problem can go unsolved. Any change in physical appearance (such as occurs with puberty or with pregnancy) can intensify or create a sexual or reproductive concern. The person with a sexually transmitted infection (STI); excessive weight loss or gain; a disfiguring scar from surgery or an unintentional injury; hair loss such as occurs with chemotherapy; surgery, inflammation, or infection of reproductive organs; chronic fatigue or pain; spinal cord injury. Puberty- stage of life at which secondary sex changes begins. in most girls, these changes are stimulated when the hypothalamus( signals) synthesizes and releases gonadotropin( Gonad= Ovary and Tropin= Growth) hormone, which then triggers the anterior pituitary to release follicles stimulating hormones and luteinizing hormone Hypothalamus- serves as gonadostat or regulation mechanism to “turn on” gonad functioning. 95lb(43kg)- ideal weight for mens Androgenic hormones- hormones responsible for muscular development, physical growth, the increase in sebaceous gland secretions that causes typical acne in both boys and girls during adolescence Males- androgenic hormones are produced by adrenal cortex and testes Females- adrenal cortex and the ovaries(dulo na bilog sa may bahay bata) The level of the primary androgenic hormone, testosterone, is low in males until puberty (between ages 12 and 14 years) when it rises to influence pubertal changes in the testes, scrotum, penis, prostate, and seminal vesicles;( lumalaki boses ng lalaki) girls, testosterone influences enlargement of the labia majora and clitoris and the formation of axillary and pubic hair. Role of Estrogen Ovarian Follicles- females begin to excrete a high level of the hormone estrogen. This increase influences the development of the uterus, fallopian tubes, and vagina; typical female fat distribution; hair patterns; and breast development. Menarche- 1st mens Thelarche- develoment ng breast. Spermatogenesis- Production of sperm Adolescent sexual development has been categorized into stages. There is wide variation in the time required for adolescents to move through these developmental stages; however, the sequential order is fairly constant. In girls, pubertal changes typically occur as: Growth spurt Increase in the transverse diameter of the pelvis Breast development Growth of pubic hair Onset of menstruation Growth of axillary hair Vaginal secretions Secondary sex characteristics of boys usually occur in the order of: Increase in weight Growth of testes Growth of face, axillary, and pubic hair Voice changes Increase in height Penile growth Spermatogenesis (production of sperm) Andrology- the study of the male reproductive organs. gynecology- the study of the female reproductive organs. Male External Structures Scrotum- rugates, skin covered, muscular pouch suspended from the perineum Testes- two ovoid glands, 2-3 cm wide. pag malamig (tumataas) pag mainit (bumababa) Fsh- release of androgen binding protein Lh- release of testosterone from testes One testis is slightly larger than the other. Penis- is composed of three cylindrical masses of erectile tissue in the penis shaft. The urethra passes through these layers of tissue, allowing the penis to serve as both the outlet for the urinary and reproductive tracts in men. With sexual excitement, nitric oxide is released from the endothelium of blood vessels. This causes dilation and an increase in blood flow to the arteries of the penis (engorgement/ lumalaki). Erectal disfunction- di nag-eerect and di tumatayo. Prepuce- protects the nerve sensitive glants at birth. (loose skin). The Epididymis The seminiferous tubule of each testis leads to a tightly coiled tube, the epididymis, which is responsible for conducting sperm from the tubule to the vas deferens, the next step in the passage to the outside. Because each epididymis is so tightly coiled, its length is extremely deceptive: It is actually over 20 ft long. Aspermia- absence of sperm Oligospermia- low in amount Vas deferens- cavity, where it ends at the seminal vesicles and the ejaculatory ducts below the bladder. Seminal Vesicles- glands secrete a viscous alkaline liquid with high sugar Prostate gland- purpose is to secrete a thin, alkaline fluid, which, when added to the secretion from the seminal vesicles, Bulbourethral gland- helps ensure the safe passage of spermatozoa. Urethra-hollow tube leading from the base of the bladder, which after passing through prostate gland. orifice of urethra- pinapasok ang catheter if napapasok ang catheter sa vagina wag agad tanggalin and gawing landmark para alam na kung saan ilalagay ang catheter( itataas ng konti) Female External Genitalia- Vulva from Latin word for “Covering” epesiotomy- cut/ opening epesiorraphy- repair Labia Minora- two hairless folds of connective tissue (Sa loob ng vagina) Labia Majora- Serve as protection for the external genitalia Vestibule- flattened, smooth surface inside the labia Clitoris- small organ( nag eerect din siya kahit maliit) young girls approaching puberty may be circumcised or have their clitoris removed with the labia minor excised as well. Aside from being a very painful procedure, female circumcision can lead to contractions and scarring of the vulva that make vaginal childbirth difficult because the vagina is unable to expand with birth. Two Skene glands (paraurethral glands) are located on each side of the urinary meatus; their ducts open into the urethra. Bartholin glands (vulvovaginal glands) are located on each side of the vaginal opening with ducts that open into the proximal vagina near the labia minora and hymen. Secretions from both of these glands help to lubricate the external genitalia during coitus. Fourchette- Ridge of tissue formed by the posterior joining of the labia minora and labia majora. this is the structure that sometimes tears( laceration) or cut ( episiotomy) Hymen- tough but elastic semicircle of tissue that covers the opening to the vagina during childhood. it is often torn during the time of 1st sexual intercourse. hematocolpometra- menstrual blood from the vagina( need isurgically incised or repair) Vulvar blood supply Pudendal artery- oxygenated red blood pudendal vein- return deoxygenated blood an advantage is that it contributes to the rapid healing of any tears in the area after childbirth or other injury. Ovaries- are located close to and on both sides of the uterus in the lower abdomen. The function of the two ovaries is to produce, mature, and discharge ova (the egg cells). it also produces estrogen and progesterone and initiates and regulate menstrual cycles. Uterus- nageexpand If the ovaries are removed before puberty (or are nonfunctional), the resulting absence of estrogen normally produced by the ovaries prevents maturation and maintenance of secondary sex characteristics; Fallopian Tubes- Their function is to convey the ovum from the ovaries to the uterus and to provide a place for fertilization o the ovum by sperm. interstitial portion- is the part of the tube that lies with the uterine wall. isthmus- portion of the tube that is cut or sealed in a tub or tubal sterilization procedure. ampulla- where fertilization of an ovum usually occurs. infundibular portion- fimbria (small hairs) that help to guide the ovum into the fallopian tube Uterus- hollow, muscular, pear-shaped organ located in the lower pelvis, posterior to the bladder and anterior to the rectum. In a nonpregnant state, it weighs approximately 60 g. The function of the uterus is to receive the ovum from the fallopian tube Provide a place for implantation and nourishment Furnish protection to a growing fetus and, At maturity of the fetus, expel it from a person's body Ectopic pregnancy- is a complication of pregnancy in which the embryo attaches outside the uterus. Vagina- acts as the organ of intercourse and conveys sperm to the cervix. Breast- mammary glands, or breasts, form early in intrauterine life. They then remain in a halted stage of development until a rise in estrogen at puberty causes them to increase in size. This increase occurs mainly because of growth of connective tissue plus deposition of fat. Menstruation A menstrual cycle (the chromosomal female reproductive cycle) is episodic uterine bleeding in response to cyclic hormonal changes.  The purpose of a menstrual cycle is to bring an ovum to maturity and renew a uterine tissue bed that will be necessary for the ovum's growth should it be fertilized.(28 days normal) 2 days mens or as long as 9 days Menstrual cycle Begins on the first day of menstrual bleeding and ends on the day before the next menstrual bleeding begins again Menstrual bleeding is due to the shedding of the uterine lining previously prepared for implantation, indicating that no implantation has occurred When the menstrual bleeding begins, several eggs have begun to grow in the ovaries The fertility cycle of a woman varies in length from below 24 days (short cycle), within 25-35 days (average cycle), to more than 36 days (long cycle) The post-ovulatory days are usually fixed in all of these cycles (11 - 16 davs) It is the pre-ovulatory days that vary in length Physiology of menstruation four body structures Hypothalamus Pituitary gland Ovaries Uterus Ovary-ovulation and the Graafian follicle ruptures termed us corpus luteum UTERUS Stimulation from the hormones produced by the causes specific monthly effects on the uterus PROBLEMS IN MENSTRUATION Dysmenorrhea - painful menstruation Amenorrhea - absence of menses Menorrhagia - excessive blood flow Metrorrhagia - bloody vaginal discharge between periods (spotting) INDICATIONS OF OVULATION Occurs 12-14 days before the onset of the next menses Uterine lining continues to thicken ready to receive the fertilized egg Slight drop of temperature about 0.5 degrees Celsius Cervical mucus is abundant, wet, slippery, stretchy, and clear | this mucus helps sperms live and swim to reach the egg; it nourishes the sperms Vaginal sensation is wet Cervical os (the opening in the cervix at each end of the endocervical canal) dilates slightly and soft Estrogen drops a bit but remains high Progesterone begins to rise Spinnbarkeit test also known as fibrosity (it can be stretched into long strands) and fern test (cervical mucus forms fernlike patterns) Fern test- kukuwa ng sample sa excretion tas titignan sa microscope. CONCEPTION 1. Natural conception - the interaction of many factors including: Correct timing between the release of mature ovum at ovulation  Ejaculation of enough healthy, mature, motile sperm into the vagina | Although exact viability is unknown, the ovum may survive no longer than 24 hours after its release at ovulation Most sperm survive no more than 24 hours in the female reproductive tract Although few may remain fertile in the woman's reproductive tract for as long as 5 days FERTILIZATION Per ejaculation the average seminal fluid is 2.5ml containing 50-200million spermatozoa per ml or 400million per ejaculation It occurs in the outer 3rd (ampullar) of the F.t Zygote- nagsama ang sperm at egg cell IMPLANTATION It takes 7-8 days from fertilization to implantation. Implantation occurs at the upper 2/3 and posterior portion of the uterus. On implantation, the structure is called the embryo, until 8-9 weeks it begins to be referred to as the fetus. Implantation bleeding results from capillary rupture on implantation and usually happens a week before the expected next menstruation. Endometrium is termed decidua on conception. HUMAN SEXUAL RESPONSE Sexual experience is unique to each individual but sexual ph features SEXUAL RESPONSE CYCLE: 4 STAGES 1. Excitement 2. Plateau 3. Orgasm 4. Resolution 1. Excitement Occurs with physical and psychological stimulation For female Clitoris increases in size Mucoid fluid to appear on vaginal walls as lubrication Vagina widens in diameter and increases in length Nipples become erect For male Penile erection scrotal thickening Elevation of testes For both sexes - increase in heart and respiratory rates and blood pressure 2. Plateau- intensifies the response from the excitement phase 3. Orgasm- Intense pleasure 4. Resolution- Return to an unaroused state. SEXUALITY | the whole you Is the totality of each individual's personhood This encompasses the individual's total personality, way of thinking, behaving, loving, and relating with God and other individuals BEING ABLE TO TALK OPENLY AND HONESTLY ABOUT SEXUALITY WILL: 1. Help us sort our feelings 2. Develop our own personal sexual standards 3. Enable us to understand others point of view 4. Obtain information needed to make responsible sexual decisions. 5. Ignorance on sexuality or lack of information about your body can also cause disappointments and inability to give and receive sexual pleasure  Our body is a gift from God | it is something to be appreciated and should not be ashamed of Human sexuality- is defined as the characteristics that make a man, a man, or a woman, a woman Include the man or woman's capability for sexual feelings and behavior Includes his or her total personality (personality encompasses individuals characteristics) 5 MAJOR COMPONENTS 1. BIOLOGICAL SEX - this pertains to being a male or female; includes biological concerns on reproductive anatomy and physiology Humans have 2 sexes - male and female Men's sperm has 2 tvpes of chromosomes (X and Y) that determines the sex of the baby | XX - female; XY - male 2. SEXUAL ORIENTATION - sexual preference of an individual with regards to the sex of a person he/ she is attracted to or the sex of his/ her partner in a sexual relationship. 3. SEXUAL IDENTITY (body image) - this pertains to a person's feelings about the body and being a man or woman It includes concerns on relationships and intimacy, sexual response, sexual awakening, and other sexual concerns, such as frigidity and impotence Two major questions associated with sexual identity Who am I sexually? How do I relate to others as a sexual partner? 4. GENDER IDENTITY - psychological sense of being male or female, and personal and or social norms for feminine or masculine behavior  Is about an individual's sex roles - social norms and values that develop the relative power, responsibilities, and behavior of women and men Prescribed gender roles, however, can be influenced and changed 5. VALUES AND ATTITUDES, FEELINGS, AND EMOTIONS - about life, love, and people each individual life has touched. Sexual Orientation Terminology for Nurses: Heterosexual: A heterosexual person is someone who finds sexual fulfillment with a member of the opposite sex. “Straight “ is often used in place “heterosexual” Homosexual: A homosexual person is someone who finds sexual fulfillment with a member of their own sex. This term is often used disparagingly against the LGBTO+ community. "Same-sex partner" and "gay" (for persons of both sexes) are often used as umbrella terms instead of "homosexual." Gay: Male-identifying individuals who are sexually attracted to male partners. This term is also sometimes used to refer to both males and females who have same-sex partners. Lesbian: Female-identifying individuals who are sexually attracted to female partners MSM- Men who have sex with men. WSW- Women who have sex with women Bisexual: People are bisexual if they achieve sexual satisfaction from both same-sex and heterosexual relationships. Transgender: An umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth. Transgender people may describe themselves using one or more of a wide variety of terms, including "transgender." Queer: An adjective used by some people to indicate their sexual orientation is not exclusively heterosexual. Sometimes, for those who identify as queer, the terms "lesbian," "gay” and "bisexual" are perceived to be too limiting and/or fraught with cultural connotations they feel don't apply to them. RESPONSIBLE PARENTHOOD Reproductive life planning- includes all the decisions an individual or couple make about whether and when to have children, how many children to have, and how they are spaced. The Primary Goal of Maternal and Child Health Nursing - promotion and maintenance of optimal family health to ensure cycles o optimal childbearing and childrearing. The Philosophy of Maternal and Child Health Nursing Family centered Community centered Evidenced based A challenged role for nurses Standard 1: Quality of care: -The nurse systematically evaluates the effectiveness of nursing practice. Standard 2: Performance appraisal -The nurse evaluates his or her own nursing practice in relation to professional practice standards and regulations. Standard 3: Education -The nurse acquires and maintains current knowledge in nursing practice. Standard 4: Collegiality -The nurse contributes to the professional development of peers, colleagues, and others. Standard 5: Ethics -The nurse's decisions and actions on behalf of patients are determined in an ethical manner. Standard 6: Collaboration -The nurse collaborates with the patient, significant others, and health care providers in providing patient care. Standard 7: Research -The nurse uses research findings in practice. Standard 8: Resource utilization -The nurse considers factors related to safety, effectiveness, and cost in planning and delivering patient Standard 9: Practice Environment -The nurse contributes to the environment of care delivery within the practice setting. Standard 10: Accountability -The nurse is professionally and legally accountable for his or her practice. The professional registered nurse may delegate to and supervise qualified personnel who provide patient care. The care of childbearing and childrearing families is a major focus of nursing practice, because to have healthy adults you must have healthy children. To have healthy children, it is important to promote the health of the childbearing woman and her family from the time before children are born until they reach adulthood. 1. Preconception care- consists of the healthcare you receive before conceiving. to determine if there are conditions that can affect your future pregnancy. -Potential risks may be reduced or eliminated by applying interventions such as medication or lifestyle changes. -Most doctors recommend receiving preconception care three to six months before the time you intend to conceive. Vaccine for pregnant: Tetanus 2. Prenatal care is healthcare you receive while you are pregnant. It is important because it helps improves your chances of having a healthy pregnancy. Your visits with your doctor may involve physical exams, imaging tests, blood tests or screening tests to detect fetal abnormalities. As children grow, families need continued health supervision and support. As children reach maturity and plan for their families, a new cycle begins, and new support becomes necessary. -The nurse's role in all these phases focuses on promoting healthy growth and development of the child and family in health and in illness. VDRL- Venereal disease research laboratory(syphilis) Measuring Maternal and Child Health / Statistical Terms Used to Report Maternal and Child Health: Birth Rate - no. of births per 1000 population Fertility Rate - no. of pregnancies per 1000 women of childbearing age  Fetal Death Rate -no. of fetal deaths weighing more than 500 g or more per 1000 live births Neonatal Death Rate Neonatal Period - 1st 28 days of life; Infant is called Neonate No. of deaths per 1000 live births occurring in the 1st 28 days of life SIDS- sudden infant Death Syndrome 1.Perinatal Death Rate Perinatal Period - 6 weeks before conception and 6 weeks after childbirth > No. of deaths of fetuses weighing > 500g and within the first 28 days of life per 1000 birth. Infant Mortality Rate - no. of deaths per 1000 live births in the first 12 months of life. Childhood Mortality rate - no. of deaths per 1000 population in children; 1 14 у/0 Maternal Mortality Rate - no. of maternal deaths per 100,000 live births that occur as direct result of reproductive process. Death of Mother- Complications Four Phases of Health Care Health promotion - educating parents and children to follow sound health practices through teaching and role modelling. Health maintenance - intervening to maintain health when risk of illness is present. Health restoration - using conscientious assessment to be certain that symptoms of illness are identified and interventions are begun to return patient to wellness most rapidly. Health rehabilitation - Helping prevent complication from illness.  helping a patient with residual effects achieve an optimal state of wellness and independence. helping a patient to accept an inevitable death Fetal Monitor- Hr ni Baby Parthograp strips Roles & Responsibilities of MCN Basic nursing skills are a necessity. Patient management pain patient and family education, assessment, diagnosis and communication. Maternal mortality ratio (MMR Philippines 2017 The maternal mortality ratio (MMRatio) is the annual number of female deaths per 100,000 livebirths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MIMRatio includes deaths during pregnancy, childbirth, or within 42days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year Basic Emergency Obstetric And New born care(BEmONC)- is a primary health care level initiative promoted in low- and middle- income countries to reduce maternal and newborn mortility. Prenatal Care(Care for the mother) Prenatal care or antenatal care- refers to the health care given to a woman and her family during pregnancy. The primary goal of prenatal care is to provide maximum health to expectant mothers and their baby. Goals of prenatal care: 1. To ensure a healthy and uncomplicated pregnancy and the delivery of a healthy infant. 2. To identify and treat high risk conditions 3. To individualize patient care. 4.To assist the patient for her preparation for labor, delivery, and puerperium. 5.To screen and identify risk factors or diseases that may affect the mother or the infant's health and life. 6.To reinforce healthy habits to the woman and her family. Definition of terms: Gravida- Refers to a pregnant woman. The number of pregnancies a woman has had regardless of the outcome of pregnancy. Nulligravida-A woman who had never been pregnant. Primigravida-A woman pregnant for the first time. Multigravida.-A woman who has had two or more pregnancies. Para- The number of pregnancies that reached viability or the number of pregnancies that reached 20 weeks or more, or number of fetus delivered with birth weight of 500 grams or more. Nullipara- A woman who has never delivered a fetus that reached the age of viability. Primipara- A woman who has completed one pregnancy to viability. Multipara.-A woman who has completed two or more pregnancies to viability. Schedule of clinic visit Prenatal visits clinic visits should begin as soon as possible after the first missed period. Subsequent clinic visits for normal pregnancy are scheduled as follows: From first visit to 32 weeks - every 4 weeks From 32 weeks to 36 weeks - every 2 weeks From 36 weeks until delivery - every week The desirable number of clinic visits according to WHO is 5 visits during the entire length of pregnancy and the minimum is 3 visits. First clinic visit The initial antepartal clinic visit is a time to obtain baseline data through interview, laboratory tests and complete physical examination. Based on the assessment findings, the nurse should identify risk conditions or factors that increase the possibility of complications for the mother and the fetus during pregnancy. Activities on initial clinic visit consist of: History taking Complete PE Lab tests Fetal assessment Health teachings Subsequent visits A. Maternal assessment 1. BP 2. Weight 3. Nutrition, discomforts, s/S, danger signals 4. Other problems and concerns of the woman A.Fetal assessment 1. Fetal heart rate 2. Quickening 3. Fundic height 4. Leopold's maneuver 5. Vaginal examination A. Health teachings 1. Normal S/S 2. Minor discomforts, prevention and management 3. Danger S/S 4. Nutrition and diet 5. Rest, exercise, and relaxation 6. Avoidance of drugs, alcohol, cigarettes, and too much caffeine 7. Clothing 8. Sexual relations 9. Emplovment 10. Travel 11. Preparation for the baby's birth, delivery and puerperium Hx of past pregnancies T refers to term births (after 37 weeks gestation) P refers to premature births A refers to abortions L refers to living children G number of pregnancies irrespective of gestational age P number of pregnancies that reached viability M multiple pregnancies GP(TPALM) anak-20 weeks Signs of first pregnancy: Uterus is tense and firm Frenulum is intact Labia majora in close apposition Vagina is narrow with numerous rugae Cervix is soft but do not admit tip of finger until the very end of the pregnancy Signs of previous pregnancy: Pendulous and lax abdominal wall Abdominal striae Labia gapes wider Hymen is transformed to myrtiform carunculae Cervix admits tip of cervix Sites of healed laceration of the cervix can be identified EDC (expected date of confinement) Naegele's Rule-is a standard way of calculating the due date for a pregnancy. It is named after Franz Karl Naegele (1778-1851), the German obstetrician who devised the rule. (JANUARY - MARCH +9 + 7) (APRIL - DEC-3+7+1) LIMP = 3 May 2007 +1 year = 8 May 2008 -3 months = 8 February 2008 +7 days = 15 February 2008 AOG (age of gestation) Mc Donald's Rule Fundic height(cm) ×2/7 = AOG in lunar months Fundic height(cm) ×8/7 = AOG in weeks Bartolomew's Rule 12 weeks - level of the symphysis pubis 16 weeks - halfway between the umbilicus and symphysis pubis 20 weeks - level of umbilicus 24 weeks - 2 fingers above the umbilicus 28-30 weeks - halfway between the umbilicus and xiphoid process 32-34 weeks - just below the xiphoid process 36 weeks - level of xiphoid process 40 weeks - at 34 weeks level due to lightening Leopold's Maneuver Is a systematic way to determine the position of a fetus inside the woman's uterus Vaginal examination Purpose: During the first clinic visit, IE is used to confirm pregnancy and gestation After 34 weeks, IE is performed to assess consistency of cervix, length and dilatation, fetal presenting part, bony architecture of the pelvis, anomalies of the vagina and perineum, including rectocele, cystocele and lesions Patient preparation: 1. Provide explanation 2. Let the client empty her bladder first 3. Provide good lighting 4. Place the client in lithotomy position with the buttocks extended slightly beyond examining table 5. Drape properly 6. Instruct the client not to: hold her breath clench fist contract perineal muscles 1. Explain the procedure 2. After the procedure, provide tissue to wipe perineum Vitamins, nutrition, and weight gain- Astandard prenatal multivitamin with iron satisfies the daily requirements of most pregnant women. Folate supplements to prevent neural tube defects are recommended prior to conception and throughout the first trimester. Substance use -Maternal alcohol consumption, smoking, or use of illicit drugs can be harmful to the fetus. Work - A woman with an uncomplicated pregnancy who is employed where there are no greater potential hazards than those encountered in routine daily life may continue to work without interruption until the onset of labor. Exercise - Healthy women with uncomplicated pregnancies should continue to exercise during pregnancy. Sexual activity Theoretically, sexual intercourse may stimulate labor due to physical stimulation of the lower uterine segment, endogenous release of oxytocin as a result of orgasm, direct action of prostaglandins in semen, or increased exposure to infectious agents. Birth defects and genetic issues - The prevalence of birth defects of medical, surgical, or cosmetic significance is 2 to 4 percent among live born infants and does not vary among ethnic groups. Both genetic and environmental factors play a role in their pathogenesis. The clinician should discuss the causes of congenital anomalies with the patient, assess the specific risk for her child, review options for and limitations of prenatal diagnosis, and decide whether additional testing and referral to a geneticist would be useful. Use of medications - Medication use is common in pregnancy All patients should be encouraged to contact their provider with an concerns and before taking any drugs (prescription, over the counter, or herbal (alternative] remedies) that were not previously approved. Constipation and diarrhea can be managed with bulk-forming preparations containing fiber (eg, Metamucil) and kaolin and pectin (Kaopectate), respectively. Nausea and vomiting may be pregnancy-related, or due to other causes. gravidarum and morning sickness)) Airline travel - Most airlines allow women to fly up to 35 to 36 weeks of gestation, although individual policies may vary. Commercial airline travel is generally safe for women with uncomplicated pregnancies. Fetal heart rate is not affected during flight if the mother and fetus are healthy. Sonography - Although early identification of growth-restricted fetuses allows for closer surveillance and earlier intervention in case of decompensation, Fetal assessment - Sonographic and cardiographic fetal assessments are indicated in patients at-risk for fetal complications. Vaginal bleeding, Leakage of fluid per vagina, Uterine contractions, Decreased fetal activity, Signs of preterm labor (eg, low, dull backache; increased uterine activity compared to previous patterns; menstrual-like cramps; diarrhea; increased pelvic pressure; vaginal leaking of clear fluid, spotting, or bleeding) Second and third trimester counseling - A number of issues may be discussed in preparation for labor and delivery. These include, but are not limited to: Route of delivery. Management of labor. Postpartum issues Breast feeding. Neonatal circumcision Routine Lab- A standard panel of laboratory tests should be obtained on every pregnant woman at the first prenatal visit. Complete Blood Count, Blood Typing Urinalysis HBSAg- to screen Hepa B Fasting Blood Sugar Test for Sexually Transmitted Diseases Ultrasound HIV testing if warranted Discomfort of Pregnancy Nawusea and Vomiting Also knows as morning sickness because it usually occurs in the morning, Commence 6 weeks after the last menstrual period and disappears by the end of the first trimester. The exact cause is not known but it has been attributed to Human Chorionic Gonadotropin. It may be psychologic in origin: ambivalence or nonacceptance of pregnancy. Most women experience nausea and vomiting In the morning but it may occur anytime of the day. Management: a Eat dry toast or cracker before rising from the bed. b. Eat small frequent meals rather than 3 large ones. Frequent urination First appears on the first trimester when the enlarging uterus exerts pressure on the bladder as it rises out of the pelvic cavity. It disappears on the second trimester when the uterus has become an abdominal organ, Frequency of urination returns late in pregnancy when the presenting part exerts pressure on the bladder. Management: a. Limit fluid intake before bedtime. Fatigue Fatigue on the first trimester is due to the action of progesterone on the sleep center of the brain. On the second and third trimester, it is thought to be due to increased metabolic rate and increased weight of the gravid uterus. Management: a, Take at least 8 hours of sleep at night and frequent rest periods during the day. Avoid standing for long periods, work while seated as much as possible. Eat a well balanced diet to provide enough energy. Breast Tenderness and Nipple Irritation Breast discomfort occurs throughout pregnancy. it is due to alveolar cell development as stimulated by increase levels of estrogen. Management: Wash breast with water only, no soaps and alcohol to prevent drying and irritation. Leukorrhea High level of estrogen causes hyperactivity of cervical glands throughout pregnancy Management. Proper perineal hygiene, flush perineum with water after each voiding, no douching is necessary. Use of sanitary pad for excessive vaginal discharge. Nasal stuffiness Elevated estrogen levels results in hyperemia of mucous membranes. Occurs throughout pregnancy. Management: Avoid allergens and smoke filled rooms. Heartburn or Pyrosis Progesterone slows down gastric motility resulting in reflux of gastric contents in the lower esophagus. The acidic nature of gastric contents cause irritation of esophageal mucosa. Management: Take small meals rather than three large ones. Bend at knees not waist when picking objects from the floor, avoid lying flat. Varicose Veins Varicosities cause largely by hereditary predisposition, advancing age, prolonged standing and exaggerated by pregnancy. It usually becomes apparent during the second and third trimester when the uterus is enlarged enough to impede return blood from the lower extremities. Management: Leg Varicosities Periodic rest with elevation of the legs, lie with feet against the wall. Leg Cramps Also known as Charley Horse, is thought to be cause by the pressure of the uterus against the nerve supplying the lower extremities. It may also be due to fatigue, chilling, insufficient calcium and excessive phosphorus in the diet. Management: For immediate relief push toe upward while applying pressure on the knee to straighten the leg. Exercise regularly but avoid pointing of toes. Headache Normal headache of pregnancy is common during the first trimester. Some cases leads to sinusitis or ocular strain caused by refractive errors. The cause is unknown. By midpregnancy, these headaches have decreased in severity or are gone. Promoting Fetal and Maternal Health: A major role in promoting fetal and maternal health is education. Generally, a woman who eats well and takes care of her own health during pregnancy provides a healthy environment of fetal growth and development. Health Promotion during Pregnancy: Daily tub baths or showers are recommended because sweating tends to increase because a woman excretes waste product for herself and a fetus. As pregnancy advances, showering to sponge bathing is recommended for their safety. During last month of pregnancy do not bath in the tub Woman should wear a firm, supportive bra wide straps to spread weight across shoulders. In halfway of the pregnancy she should buy a larger Bra to accommodate increased breast size. Colostrum begins to secrete on the 16th week, it may be rightening if she is not warned, instruct her to wash the breast with clean tap water ( no Soap because this could be drying) daily to remove and reduce infection. If secretion is heavy, place a gauze pad inside the bra. Brushing teeth every after meals. Encourage to see her dentist or examinations and cleaning. Encourage woman to snack on nutritious foods such as fresh fruits and vegetables like apples, carrots to avoid sugar in mouth and teeth.  Douching is not allowed because it alters the ph of the vagina leading to bacterial growth Woman should avoid garters, firm girdles, knee-high stockings because it impedes lower extremity circulation. Comfort and common sense are The basic rule. Coitus is not restricted during pregnancy Well nourished women should exercise during pregnancy everyday for 30 minutes. Exercise is important to prevent circulatory stasis in the lower Extremities, and offer general feeling of well being. An exercise program must start with 5 minutes warm-up, 20 minutes active stimulus and 10 minutes cool down exercises. Sims position with the top leg forward because this puts the weight of the fetus on the bed, not on the woman and allows good circulation in the Lower extremities.. Avoid resting in a supine position because this would lead to hypotension syndrome because of the pressure of the expanding Uterus on the inferior vena cava. Travelling by plane is not prohibited as long as its pressurized cabin. NUTRITION: 1. Calorie Needs - a total of 2500 caloric intake is recommended during pregnancy to supply energy for the fetus and placenta as well as to sustain an elevated metabolic rate. 2. Protein intake - the intake of protein increases to 60g daily. This is best supplied by meat, poultry, fish, yogurt, eggs and milk. 3. Fat Needs - it is recommended to use vegetables oils rather than animal oils to prevent hypercholesterolemia and coronary heart disease. 4. Vitamin needs - vitamin intake should not be underestimate by the women because lack of vitamins may result to pregnancy problems. Example is Vitamin D, which is essential for calcium absorption. Mineral needs Calcium and phosphorus - skeleton and teeth constitute a major portion of the fetus. Tooth formation begins as early as 8 weeks in utero. To meet the adequate supply of calcium and phosphorus for bone formation, pregnant women need to eat foods high in calcium and vitamin D. lodine - essential for formation of thyroxine and therefore, proper functioning of thyroid gland.if not met, may result to goiter of the mother or fetus that will lead to early respiratory distress. Iron - need to build a high level of hemoglobin in the fetus to meet the necessary oxygenation during the intrauterine life. Fluoride - also aids in the formation of teeth. Sodium - needs to maintain the normal fluid balance in the body. Excess sodium is contraindicated when the mother is hypertensive since this will result to retention of fluid thus putting restrain on her heart as blood volume doubles. Zinc - necessary for DNA and RNA synthesis Fluid Needs - needed to promote kidney function because women must excrete waste products for two. Two glasses of fluid daily over and above a daily quart of milk is a common recommendation Fiber Needs - for constipation. Foods to Avoid During Pregnancy: Food with caffeine Artificial sweeteners - Aspartime, Equal, etc Weight loss Diets