Care Of Mother, Child, Adolescent PDF

CARE OF MOTHER,CHILD, ADOLESCENT (WELL CLIENTS) PREGNANCY Obstetrical terms Gravida – woman who is pregnant Gravidity – pregnancy Parity – number of pregnancies whose fetus have reached the age of viability Multigravida - woman who has 2 or more pregnancies Multipara – woman who has compl...

CARE OF MOTHER,CHILD, ADOLESCENT (WELL CLIENTS) PREGNANCY Obstetrical terms Gravida – woman who is pregnant Gravidity – pregnancy Parity – number of pregnancies whose fetus have reached the age of viability Multigravida - woman who has 2 or more pregnancies Multipara – woman who has completed 2 or more pregnancies PREGNANCY Obstetrical terms Nulligravida – woman who has never been pregnant Nullipara - woman who has not completed pregnancy with a fetus who have reached the stage of viability Primigravida – woman who is pregnant for the first time Primipara – woman who has completed one pregnancy with a fetus who have reached the stage of viability Viability – capacity to live outside the uterus which about >20 weeks or > 500 grams PREGNANCY Obstetrical terms Term – 38 – 42 weeks Post date – Postterm - > 42 weeks Preterm – 21 to 37 weeks premature – 21 to 27 weeks (----) Abortion - < 20 weeks or < 500 grams PREGNANCY Obstetrical terms Preterm: born before 37 weeks Gestation: time elapsed, measured in weeks since 1st day of last menstrual period FHT = fetal heart tones ( FHR = fetal heart rate ) Normal = 120 - 160 bpm by Doppler heard at 10 - 12 weeks by fetoscope heard at 18 - 20 weeks Quickening: The first movement of the fetus felt by the mother 10-12 movements per hour felt after 20 weeks PREGNANCY Obstetrical terms Abortion:medical term for any pregnancy terminated before age of viability Miscarriage: lay term meaning spontaneous abortion  Viability: survivability – 20 -24 weeks – Wt. > 400 grams Gravida: any pregnancy, regardless of duration, including present pregnancy PREGNANCY Obstetrical terms ENGAGEMENT: the largest diameter of the presenting part reaches or passes through pelvic inlet LIGHTENING: fetus begins to settle into the pelvic inlet The baby drops Can breathe easier Occurs 10 - 14 days before labor in primiparas & just before labor in multiparas Increased leg cramps, pain, & pelvic pressure Urinary frequency Braxton-Hicks contractions BALLOTTEMENT: the fetus is freely moving or floating above the inlet PREGNANCY Obstetrical terms PARA: number of children born after 20 weeks, alive or dead; multiple births counted as 1 para. GTPAL: G - gravida T - term or full term P - preterm A - abortion L - living children M - multiple births PREGNANCY gestational process, comprising the growth and development within a woman of a new individual from conception through the embryonic and fetal periods to birth Other name: gestation, fecundation, impregnation, conception Gestation – period from the fertilization of the ovum until birth PREGNANCY PREGNANCY Signs of Pregnancy Presumptive – subjective – sign that suggest but do not confirm pregnancy and could be due to other condition Probable – objective – strong indication of pregnancy not likely but still possibly due to another condition. Positive – signs definitively confirming pregnancy PREGNANCY Signs of Pregnancy (Presumptive)  Amenorrhea Morning sickness Breast changes Fatigue Urinary Frequency Enlarging Uterus Quickening Leucorrhea Weight Changes Increased skin pigmentation: - Chloasma - Linea nigra - Striae gravidarum PREGNANCY Signs of Pregnancy (Probable) Positive HCG Chadwick’s Goodell’s Hegar’s Ballottement Braxton Hicks contraction ASSESSMENT AND DIAGNOSIS HUMAN CHORIONIC GONADOTROPHIN (hcg) Can be tested in serum after 24 – 48 hours after implantation in the urine - 1st morning void and can be detected 26 days after conception Peak level between 60 – 70 days will last until 100 – 130 days then it will go down. In post partum women it will become negative in serum testing after 1 – 2 weeks after delivery Pregnancy Signs of Pregnancy (Positive) Ultrasound evidence Fetal heart tones Fetal movements Fetal outline on X-ray Physiological Changes during pregnancy Physiological Changes during pregnancy Local Changes 1. Cervix - Goodell’s sign 2. Uterus - Hegar’s sign 3. Vagina - Chadwick’s sign 4. Abdominal Wall - Striae gravidarum 5. Skin - Chloasma gravidarum and Linea nigra 6. Breasts 7. Ovaries Systemic Changes 1. Circulatory/Cardiovascular 2. Gastrointestinal changes 3. Respiratory Changes 4. Urinary changes 5. Musculoskeletal changes 6. Endocrine changes 7. Temperature 8. Metabolism 9. Reproductive system Physiological Changes during pregnancy Cardiovascular/Circulatory Increase metabolic demand of new tissue growth Expansion of the vascular channel especially the genital tract Increased in the steroid hormones which exerts a positive effect on sodium and water balance Blood volume: a. Increases progressively throughout pregnancy, beginning in the first trimester and peaking in the middle of the third trimester at about 45% above prepregnant levels. b. Normal blood pressure maintained by peripheral vasodilatation. c. Extra volume of blood acts as a reserve for blood loss during delivery. Physiological Changes during pregnancy Cardiovascular/Circulatory Heart A. Increase in heart rate; ten beats per minute by the end of the first trimester B. Increase in cardiac output C. Palpitations of the heart usually due to sympathetic nervous system disturbance; later in pregnancy due to the intra abdominal pressure of the growing uterus. D. Cardiac enlargement and systolic murmurs. Blood Pressure – falls during the second trimester; rises slightly (no more than 15 mm in either systolic or diastolic) during the last trimester Physiological Changes during pregnancy Cardiovascular/Circulatory Red Blood Cells Stimulation of the bone marrow leads to a 20-30% increase in total RBC volume. The plasma volume increase is greater than the RBC increase which leads to a hemodilution, typically referred to as physiologic anemia of pregnancy (pseudoanemia). White blood cells (WBC): 10 to 11,000 per cu mm; may increase up to 25,000 per cu mm during labor and postpartum. Physiological Changes during pregnancy Cardiovascular/Circulatory Total plasma proteins: decrease due to fall in serum albumin level. Sedimentation rate: increases due to the decrease in plasma proteins.  Fibrin level increases as much as 40% at term with the plasma fibrinogen level increasing as much as 50%. Pregnancy induced hypervolemia – To meet the demands of the enlarged uterus with it greatly hypertrophied vascular system To protect the mother and in turn the fetus, against deleterious effects of impaired venous return in the supine and erect position To safeguard the mother against the adverse effects of blood loss associated with parturition Physiological Changes during pregnancy Cardiovascular/Circulatory Physiological Changes during pregnancy Total iron requirements 1 gram or 6 -7 mg/day - 300 mgs used by the fetus and placenta - 200 mgs are excreted - 500 mgs are used in erythrocyte production Physiological Changes during pregnancy Respiratory system Oxygen consumption increased by 15-20% between the sixteenth and fortieth weeks. Diaphragm is elevated; change from abdominal to thoracic breathing around the twenty-fourth week. Tidal volume increases steadily throughout pregnancy. Tidal volume - amount of air moving in and out of the lungs in one normal breath. Physiological Changes during pregnancy Respiratory system Vital capacity increases slightly, while pulmonary compliance and diffusion remain constant. Vital capacity-amount of air inhaled and forcibly exhaled in one breath. Common complaints of nasal stuffiness and epistaxis due to estrogen influence on nasal mucosa. Physiological Changes during pregnancy Urinary system Reduced renal threshold for sugar; leads to glycosuria. Due to an increased glomerular filtration rate (GFR), as much as 50%, there is a decreased serum BUN, creatinine, and uric acid. Physiological Changes during pregnancy Physiological Changes during pregnancy Gastrointestinal tract Pregnancy gingivitis-gums reddened, swollen, and bleed easily. Increased saliva (ptyalism); decreased gastric acidity. Nausea and vomiting due to elevated human chorionic gonadotropin (HCG). Decreased tone and motility of smooth muscles Decreased emptying time of stomach  Slowed peristalsis due to increased progesterone lead to complaints of bloating, heartburn, and constipation. Pressure of expanding uterus leads to hemorrhoidal varicosities and contributes to continuing constipation Physiological Changes during pregnancy Hyperemesis Gravidarum It is a syndrome of excessive nausea and vomiting due to excessive hormonal changes of pregnancy, especially HCG. - characterized by the pernicious vomiting during pregnancy. It occurs in every one thousand pregnancies, the cause is debatable but seems to be related to HCG and psychological factors. Physiological Changes during pregnancy Hyperemesis Gravidarum (treatment) a. antivomiting – Bendectin (Doxylamine succinate plus pyridoxine). b. Dietary – NPO for first 48 hours, after condition improves, then six small feedings alternated with liquid nourishment in small amounts every one to two hours, if vomiting reoccurs, NPO and IV Fluids c. Effective psychological support can be offered in the form of reassurance to the pregnant woman that these symptoms will disappear by the fourth month d. prompt correction of fluid and electrolytes imbalances. Stress and emotional factors have been found to play a major role in hyperemesis gravidarum, psychotherapy is recommended Physiological Changes during pregnancy Musculoskeletal System Increase in the normal lumbosacral curve leads to backward tilt of the torso. Center of gravity is changed which often leads to leg and back strain and predisposition to falling. Pelvis relaxes due to the effects of the hormone relaxin; leads to the characteristic "duck waddling" gait. Physiological Changes during pregnancy Endocrine changes Placenta a. Functions include transport of nutrients and removal of waste products from the fetus. b. Produces human chorionic gonadotropin (HCG) and human placental lactogen (HPL). c. Produces estrogen and progesterone after two months of gestation. Physiological Changes during pregnancy Endocrine changes Thyroid gland. May increase in size and activity. b. Increase in basal metabolic rate. Parathyroid glands-increase in activity (especially the last half of the pregnancy) due to increased requirements for calcium and vitamin Physiological Pituitary gland. a. Enlargement greatest during the last month of gestation. b. Production of anterior pituitary hormones: FSH, LH, thyrotropin, adrenotropin, and prolactin. c. Production of posterior pituitary hormones: oxytocin which promotes uterine contractility and stimulation of milk let-down reflex Physiological Changes during pregnancy Adrenal glands a. Hypertrophy of the adrenal cortex. b. Increase in aldosterone, which retains sodium, results in a decreased ability of the kidneys to handle salt during pregnancy; consequently, improper control of dietary sodium can lead to fluid retention and edema. Physiological Changes during pregnancy Metabolism Weight gain. a.Normal weight gain: 25 to 35 lbs. b. Pattern of weight gain. (1) First trimester- 3 to 4 lbs. (2) Second trimester- 12 to 14 lbs. (3) Third trimester-8 to 10 lbs. c. Total weight gain is accounted for as follows: (1) Fetus: 7.5 lb. (2) Placenta and membranes: 1.5 lb. (3) Amniotic fluid: 2 lb. (4) Uterus: 2.5 lb. (5) Breasts: 3 lb. (6) Increased blood volume: 2-4 lb. (7) Remaining 4-9 lb. is extravascular fluid and fat reserves Physiological Changes during pregnancy Reproductive system Uterus Increase in size due to hypertrophy of the myometrial cells (increase seventeen to forty times their prepregnant state) as a result of the stimulating influence of estrogen and the distention caused by the growing fetus. Weight increases from 50 to 1,000 grams. Increase in fibrous and connective tissues which strengthen the elasticity of the uterine muscle wall. Physiological Changes during pregnancy Reproductive system Uterus Hegar's sign - Softening of the lower uterine segment (Hegar's sign). Irregular, painless uterine contractions (Braxton-Hicks) begin in the early weeks of pregnancy; contraction and relaxation assist in accommodating the growing fetus. Multigravidas tend to report a greater incidence of Braxton-Hicks than primigravida Physiological Changes during pregnancy Reproductive system Cervix  Softening of the cervix due to increased vascularity, edema, and hyperplasia of cervical glands (Goodell's sign). Formation of the mucous plug to prevent bacterial contamination from the vagina. Physiological Changes during pregnancy Reproductive system Breasts Increase in breast size accompanied by feelings of fullness, tingling, and heaviness. Superficial veins prominent; nipples erect; darkening and increase in diameter of the areola. Thin, watery secretion, precursor to colostrum, can be expressed from the nipples by the end of the tenth week. Physiological Changes during pregnancy Integumentary System Skin Increased skin pigmentation in various areas of the body. a. Facial: mask of pregnancy (chloasma). b. Abdomen: striae (red purple stretch marks) and linea nigra (darkened vertical line from umbilicus to symphysis pubis). Appearance of vascular spider nevi, especially on the neck, arms and legs. Acne vulgaris, dermatitis, and psoriasis usually improve during pregnancy. ASSESSMENT AND DIAGNOSIS HUMAN CHORIONIC GONADOTROPIN (hcg) Can be tested in serum after 24 – 48 hours after implantation in the urine - 1st morning void and can be detected 26 days after conception Peak level between 60 – 70 days will last until 100 – 130 days then it will go down. In postpartum women it will become negative in serum testing after 1 – 2 weeks after delivery