CARE OF MOTHER,CHILD, ADOLESCENT (3).pdf

CARE OF MOTHER,CHILD, ADOLESCENT (WELL CLIENTS) CHANGES OF THE EXPECTANT FAMILY Pregnancy is considered a normal maturational crisis and developmental stage for the expectant couple. Pregnancy is physiologic Changes in the Father First trimester 1. May feel left out of pregnancy. 2. Confused by...

CARE OF MOTHER,CHILD, ADOLESCENT (WELL CLIENTS) CHANGES OF THE EXPECTANT FAMILY Pregnancy is considered a normal maturational crisis and developmental stage for the expectant couple. Pregnancy is physiologic Changes in the Father First trimester 1. May feel left out of pregnancy. 2. Confused by partner's mood swings. 3. Couvade syndrome is caused by stress, anxiety and empathy for the pregnant women and the father will also experience physical symptoms of nausea, vomiting and backache or similar symptoms of discomfort along with his partner. Changes in the Father 2nd trimester 1. Promote his involvement by his watching and feeling fetal movement. 2. Needs to confront and resolve his own conflicts about the fathering he received as a child. 3. Will decides on what he does and does not want to imitate from his father's role figure. 4. May react differently to a partner's physical body changes. Changes in the Father 3rd trimester 1. Concerns and fears resurface. Psychological Tasks of pregnancy First trimester – accepting the pregnancy Second trimester – accepting the baby Third trimester – preparation for parenthood, reworking developmental tasks, role playing and fantasizing Factors that affect attitude towards pregnancy Social influences Cultural influences Family influences Individual influences Psychological responses Ambivalence Couvade syndrome Grief Changes in sexual desire Narcissism changes in expectant family Acceptance Introversion Mood swings Body image / boundary changes Stress First Trimester AMBIVALENCE - about pregnancy a pregnant woman focuses only on herself. The fetus is an unidentified concept with great future implications but without tangible evidence of reality. Some degree of rejection, denial and disbelief, even repression Conflicting feelings about pregnancy If women feels comfortable in addressing ambivalent feelings, the focus is usually on changed life style or the career - motherhood dilemma First Trimester AMBIVALENCE Indirect evidence of ambivalence: a. Complaints of depression or physical discomfort. b. Complaints of feeling ugly or unattractive. c. Some women may consider the possibility of abortion, if pregnancy is unwanted First Trimester AMBIVALENCE Implication: when giving health teachings, be sure to emphasize the bodily changes in pregnancy. I am pregnant....Accept the biological fact of pregnancy 2nd Trimester ACCEPTANCE – of motherhood and awareness and interest in the fetus fetus is perceived as a separate entity Fantasizes the appearance of the baby. I am going to have a baby… Accept the growing fetus as distinct from self & as person to care for 2nd Trimester With an unplanned pregnancy, there is greater evidence of fear and conflict along with more physical discomfort and depression. If pregnancy is well accepted, women experiences less discomfort and more tolerance to physical discomforts during the last trimester. 2nd Trimester Introversion 1. This "turning in on oneself' focus is normal. 2. Helps the mother plan, adjust, adapt, build, and draw strength in preparation for childbirth. 2nd Trimester Mood swings/Emotional lability Can cause difficulty in the relationship if couple doesn't realize what is occurring. Husband may feel exasperated with her tears and withdraw and ignore problem when she really needs him to be affectionate and supportive 3rd trimester EMOTIONAL LABILITY assuming already the mother, fears & fantasies & dreams about labor has personal identification with a real baby about to be born and realistic plans for future child care responsibilities. Best time to talk about preparation of infant feeding method. 3rd trimester Fear of death, though, is prominent to allay fears, let pregnant women listen to the fetal heart tones. I am going to be a mother...Prepare realistically for birth & parenting 3rd trimester Body images changes Woman may feel negative toward body, especially during 3rd trimester Psychological tasks of the mother Ensuring safe passage through pregnancy, labor, and birth. Seeking acceptance of this child by others. Seeking commitment and acceptance of self as mother to the infant (binding-in). Learning to give of oneself on behalf of one's child. ANTENATAL CARE Assessment A. Initial visit. 1. Complete history and physical. 2. Obstetric history. a. Past pregnancies (date, course of pregnancy, labor and postpartum; information about infant and neonatal course). b. Present pregnancy Prenatal Surveillance Fetal – a. heart rate (s) b. size c. amount of amniotic fluid d. presenting part and station in late pregnancy e. Activity Maternal assessment A. blood pressure – actual and extent change B. weight – actual and extent change C. symptoms including headache, altered vision, abdominal pain, nausea and vomiting, bleeding, fluid from vagina and dysuria D. height in cm. of uterine fundus from symphysis Maternal assessment E. vaginal examination in late pregnancy often provides valuable information: - confirmation of presenting part - station of the presenting part - clinical estimation of pelvic capacity and its general configuration - consistency, effacement and dilatation of the cervix - position of presenting part Maternal assessment B. Schedule of return prenatal visits. 1. Frequency of return visits. a.. Monthly for the first thirty-two weeks. b. Every two weeks to the thirty- sixth week. c. After the thirty-sixth week, weekly until delivery. Maternal assessment 2. Subsequent assessment data follow-up. a. Vital signs. b. Urinalysis-check for protein and sugar. c. Monitor weight. d. Measurement of height of uterine fundus e. Auscultation of fetal heart rate (FHR). Physical Assessment Vital signs Cephalocaudal assessment Abdomino/Pelvic exam: - Leopold’s maneuver - Speculum -IE - Pelvic measurement Physical Assessment Leopold’s Maneuver determine the orientation of the fetus through abdominal palpation Purpose: - to determine presentation, position and ATTITUDE - estimate fetal size - locate fetal parts/FHB or FHT Physical Assessment Palpate with warm hands, cold hands cause abdominal muscle to contract Use palms not fingers – educate them Position patient on supine with knee flex slightly (dorsal recumbent) so as to relax abdominal muscles Apply gently but firm motions Abdominal examination should be conducted systematically employing the 4 maneuver’s. The mother should be in with her abdomen bared. Physical Assessment L 1-Palpation of the fundus The fundus is gently palpated between the palms of two hands The upper pole (in this case the breech) is identified Characteristically the breech is softer than the head, there is no angle formed by the neck and the surface continues smoothly with the back Physical Assessment L 2 - Palpation of the body The palpation continues down the body of the uterus  The smooth back is palpated and identified The irregular surface created by the limbs, hands and feet is identified Physical Assessment L 4 - Assessing engagement Facing the woman’s feet The vertex is palpated using both hands An assessment is made of how much of the head can be palpated and whether the head is engaged, fixed or mobile Physical Assessment Physical Assessment Fundal height (Fundic) Physical Assessment Fundal height (Fundic) More accurate assessment of fundal height involves direct measurement in centimeters of the distance from the symphysis pubis to the top of the fundus Physical Assessment Technique in measuring Fundal height The woman lies supine The pubic symphysis is identified The zero end of the tape measure is held against it Tape is stretched over the abdomen A hand on top of the tape applies gentle pressure to palpate the top of the fundus An estimate of fundal size can thus be made Diagnostic tests CBC, Blood typing - Urinalysis - Hep. B Profile - HIV - Vaginal Smear – Paps smear - UTZ - Rubella titer - OGTT (DM) Estimations Naegele’s Rule McDonald’s Method Bartholomew’s Rule Haase’s Rule Johnson’s Rule Ultrasound - BPD Estimations  McDonald’s Method (Age of gestation) - – determines age of gestation by measuring from the fundus to the symphysis pubis (in cm.) then dividing by 4 = AOG in months. Bartholomew’ s rule - Estimates AOG by the relative position of the uterus in the abdominal cavity. By the 3rd lunar month, the fundus is palpable slightly above the symphysis pubis On the 5th lunar month, the fundus is at the level of the umbilicus On the 9th lunar month, the fundus is below the xiphoid process Estimations Uterine fundal height can indicate pregnancy duration It is a crude method depending on body build, examiner technique, fetal growth, accurate dates, etc It is better to measure the height of the fundus to the pubic bone and compare to a standard chart Even better estimation of gestation and fetal development is obtained by ultrasonography 34 weeks just below xiphisternum 28 weeks midway between umbilicus and xiphisternum 20 weeks at the umbilicus 16 weeks midway between pubic bone and umbilicus 12 weeks just above pubic bone Estimations Haase’s Rule Determines the length of the fetus in centimeters. During the first half of pregnancy, square the number of the month (E.g., first lunar month: 1 x 1 = 1 cm.) During the second half of pregnancy, multiply the month by 5 (E.g., 6th lunar month: 6 x 5 = 30 cm. Johnson’s Rule Estimate the weight of the fetus in grams. Formula: fundal height in cm. – n x k “k” is a constant, it is always 155 “n” is = 12 ( if fetus is engaged) = 11 (if fetus is not yet engaged)