Care of Mother, Child, Adolescent PDF

CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107 CHAPTER 3: PSYCHOLOGICAL CHANGES, DANGER SIGNS, AND DISCOMFORTS FACTORS THAT INFLUENCE THE WOMAN’S ATTITUDE TOWARDS 4) Perineal hygiene PREGNANCY...

CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107 CHAPTER 3: PSYCHOLOGICAL CHANGES, DANGER SIGNS, AND DISCOMFORTS FACTORS THAT INFLUENCE THE WOMAN’S ATTITUDE TOWARDS 4) Perineal hygiene PREGNANCY - Maintain good perineal hygiene. 1. SOCIAL - Caution them to always wipe front to back after voiding to Personal experiences prevent contamination forward from the rectum. 5) Clothing Experiences of friends & relatives - Women should be cautioned to avoid garters, extremely 2. CULTURAL firm girdles with panty legs, and knee-high stockings Beliefs during pregnancy because these may impede lower Taboos extremity circulation. 3. FAMILY - Suggest wearing shoes with a moderate-to-low heel to The family in which the woman was raised. minimize pelvic tilt and possible backache as well as to reduce the risk of falling. 4. INDIVIDUAL 2. SEXUAL ACTIVITY Woman’s ability to cope with or adapt to stress Ability to adapt to being a mother Women who have a history of previous preterm birth should consult their obstetric provider for specific advice. EMOTIONAL RESPONSES Women whose membranes have ruptured or who have vaginal 1. Ambivalence spotting should be advised against coitus until examined by 2. Grief their primary care provider to prevent possible infection or 3. Narcissism complications. 4. Introversion vs. Extroversion Changes in sexual position may be needed to increase comfort. 5. Body Image & Boundary 6. Stress 3. EXERCISE 7. Couvade Syndrome 220 – 20 (age of woman) = 200 x 70% = 140 bpm 8. Emotional Lability Walking is the best exercise during pregnancy. 9. Changes in Sexual Desire Women should be encouraged to take a walk daily unless 10. Changes in the Expectant Family inclement weather, many levels of stairs, or an unsafe PSYCHOLOGICAL TASKS THE PREGNANT WOMAN HAS TO neighborhood are contraindications. ACCOMPLISH IN EACH TRIMESTER Yoga is also a good exercise as long as positions are limited to those in which pregnant women are able to maintain balance. TASK IN EACH TRIMESTER DESCRIPTION Swimming is a good activity for pregnant women and, like 1st TRIMESTER Common reaction is bathing, is not contraindicated as long as membranes are Task: Accepting the Pregnancy ambivalence intact. 2nd TRIMESTER Begins to imagine herself 4. SLEEP Task: Accepting the Baby as a mother (anticipatory role- playing) Growth hormone secretion is at its highest level—that is, Woman feels fetal during sleep. movement A good resting or sleeping position is a left-sided Sims 3rdTRIMESTER “Nest-building” activities position, with the top leg forward. Task: Preparing for the Baby & Role-playing 5. EMPLOYMENT Parenthood Fantasizing May continue to work unless a woman’s job involves exposure HEALTH PROMOTION to toxic substances, lifting heavy objects, other kinds of excessive physical strain, long periods of standing or sitting, or 1. SELF-CARE NEEDS having to maintain body balance. 1) Bathing 6. TRAVEL - Daily tub baths or showers are recommended. - Heat exposure for a lengthy time could lead to Advise a woman who is taking a long trip by automobile to hyperthermia in the fetus and birth defects (specifically plan for frequent rest or stretch periods. esophageal atresia, omphalocele, and gastroschisis). o Preferably every hour, but at least every 2 hours, she 2) Breast care should get out of the car and walk a short distance. - Wear a firm, supportive bra with wide straps. o This break relieves stiffness and muscle aches and - Teach her to wash her breasts with clear tap water (no improves lower extremity circulation, helping prevent soap, because that could be drying and cause her nipples varicosities, hemorrhoids, and thrombophlebitis. to crack) daily to remove the colostrum and reduce the Caution her not to eat unwashed fruits or vegetables or raw risk of infection. meats and not to drink unpurified water. 3) Dental care She should make arrangements to visit a healthcare provider - There is a strong correlation between poor oral health and in that area so she can keep the schedule of her regular preterm birth, so maintaining good oral health during prenatal visits. Also, make certain she has enough of her pregnancy is important. prescribed vitamin supplement plus adequate prescriptions for - When bacteria in the mouth interact with sugar, this refills as necessary. lowers the pH of the mouth, creating an acid medium that can lead to etching or destruction of the enamel of teeth. LAMAGON | BSN 2A  CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107 CHAPTER 3: PSYCHOLOGICAL CHANGES, DANGER SIGNS, AND DISCOMFORTS MINOR BODY CHANGES OF PREGNANCY (1ST TRIMESTER) Urine can be identified by Nitrazine paper as urine is acidotic 1. Breast tenderness - wide strap bra (the test strip turns yellow), whereas amniotic fluid is alkaline 2. Palmar erythema (palmar pruritus) (the strip turns blue). - Due to increased estrogen 5. ABDOMINAL OR CHEST PAIN - May apply calamine lotion Abdominal pain could be a sign of: 3. Constipation 1) Tubal (ectopic) pregnancy 4. Nausea, vomiting and pyrosis (heartburn) 2) Separation of the placenta (abruptio placenta) 5. Fatigue 3) Preterm labor (regular contractions, cervical changes) - Due to increased metabolic requirement 4) Appendicitis - Increase amount of rest & sleep 5) Ulcer, or pancreatitis. 6. Muscle cramps Chest pain and shortness of breath may indicate a pulmonary - Dorsiflex foot; elevate LE freq., embolus, a complication that can follow thrombophlebitis. - Due to decreased serum calcium levels, increased serum phosphorus levels, and possibly, interference with 6. INCREASE OR DECREASE IN FETAL MOVEMENT circulation. Sandovsky method = Normal: 10-12x/hr. - Take a calcium supplement. 7. GESTATIONAL HYPERTENSION - Take magnesium lactate or citrate once in the morning Usually after 20 weeks of pregnancy. and again in the evening as this bind phosphorus in the S/Sx: intestinal tract and thereby lower its circulating level 1) Rapid weight gain 7. Hypotension - Over 2 lbs/week in 2nd tri, 1 lb/week 3rd tri 8. Varicosities - elevate leg 15-20 min 2x/day (Normal: 3-12-12) 9. Hemorrhoids 2) Swelling of the face or fingers 10. Heart palpitations 3) Flashes of light or dots before the eyes - Due to increased blood volume 4) Dimness or blurring of vision - Gradual, slow movements will help prevent this from 5) Severe, continuous headache happening. - May signal cerebral edema or acute hypertension. 11. Frequent urination 6) Decreased urine output (Normal: 30 ml/hr) - Void as often as necessary, as urine stasis can lead to 7) Right upper quadrant pain unrelated to fetal position infection. - Ischemia of the liver - Perform Kegel exercises are exercises designed to 8) Blood pressure increased above 140/90 mmHg strengthen the pubococcygeal muscles. Each is a separate exercise and should be done about three times per day. PREVENTING FETAL EXPOSURE TO TERATOGENS 12. Abdominal discomfort What is a teratogen? 13. Leukorrhea o It is any factor, chemical or physical, that adversely affects the fertilized ovum, embryo or fetus. MINOR BODY CHANGES OF PREGNANCY (LATE PREGNANCY) o It is any agent that can induce or increase the incidence of 1. Backache – pelvic rock/tilt; squat instead of bend a congenital malformation. 2. Headache – due to expanding blood volume 3. Dyspnea EFFECTS OF TERATOGENS ON THE FETUS 4. Ankle edema – due to general fluid retention Factors that influence the amount of damage a teratogen can 5. Braxton Hicks contractions cause: COMPLICATIONS OF PREGNANCY (DANGER SIGNS) 1. STRENGTH OF TERATOGENS Ex: radiation 1. VAGINAL BLEEDING All women with spotting need further evaluation. 2. TIMING OF THE TERATOGENIC INSULT If a teratogen is introduced before implantation, for example, 2. PERSISTENT VOMITING either the zygote is destroyed, or it appears unaffected. Persistent or extended vomiting depletes the nutritional If the insult occurs when the main body systems are being supply available to a fetus and thus is a danger to the formed (in the second to eighth weeks of embryonic life), a pregnancy. fetus is very vulnerable to injury. 3. CHILLS AND FEVER OR PAIN ON URINATION During the last trimester, the potential for harm again May indicate an intrauterine infection, a potentially serious decreases because all the organs of a fetus are formed and are complication for both a woman and a fetus. merely maturing. Pain on urination is a symptom of a urinary infection, and is 3. TERATOGEN’S AFFINITY FOR SPECIFIC BODY TISSUES associated with preterm birth. Lead and mercury, for example, attack and disable nervous 4. SUDDEN ESCAPE OF CLEAR FLUID FROM THE VAGINA tissue. Means the membranes have ruptured. Thalidomide (Immunoprin), originally used to treat nausea in Umbilical cord may prolapse. pregnancy, is now prescribed for cancer therapy, and it may If the fetal head then presses on the misplaced cord, cause limb defects. oxygenation can be compromised and the fetus will be in Tetracycline (Apo-Tetra), a common antibiotic, causes tooth immediate and grave danger. enamel deficiencies, and possibly, long bone deformities. LAMAGON | BSN 2A  CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107 CHAPTER 3: PSYCHOLOGICAL CHANGES, DANGER SIGNS, AND DISCOMFORTS The rubella virus affects many organs, with the eyes, ears, o All pregnant women should avoid contact with children heart, and brain the four most commonly attacked. with rashes. TERATOGENIC MATERNAL INFECTIONS o Nurses who care for pregnant women or newborns Teratogenic maternal infections involve viral, bacterial, or should receive immunization against rubella. protozoan organisms, which cross the placenta from mother to All women w/ low rubella titers should be immunized to fetus. provide protection against rubella in future pregnancies. Malaria o A titer greater than 1:8 suggests immunity to the disease. o Caused by intraerythrocytic protozoa of the genus o A titer of less than 1:8 suggests a woman is susceptible to Plasmodium transmitted to humans by the bite of an viral invasion. infected female Anopheles mosquito. o A titer that is greatly increased over a previous reading or o Healthcare providers can contract it from infected blood is initially extremely high suggests a recent infection has products. occurred. o During pregnancy, women can transmit malaria to a CYTOMEGALOVIRUS (CMV) fetus. Cytomegalovirus (CMV), a member of the HSV family. o A number of drugs, such as chloroquine (Aralen) in the Can cause extensive damage to a fetus while causing few first trimester and mefloquine (Lariam) in the second or symptoms in a woman (Martin & Satin, 2015). third trimesters, are helpful. Not sexually transmitted but spreads from person to person by o Women who will be visiting an area known to be droplet infection such as occurs with sneezing. epidemic for malaria can begin treatment as prophylaxis If a woman acquires a primary CMV infection during up to 2 weeks before travel. pregnancy and the virus crosses the placenta. When newborns are tested to see if antibodies against the o The infant may be born with severe neurologic challenges common infectious teratogenic diseases are present, the test is (e.g., hydrocephalus, microcephaly, or spasticity) or with described collectively under the umbrella term TORCH: eye damage (e.g., optic atrophy or chorioretinitis), hearing o Toxoplasmosis impairment, orchronic liver disease. o Rubella o The newborn’s skin may be covered with large petechiae o Cytomegalovirus (i.e., “blueberry-muffin” lesions). o Herpes simplex virus Because a woman has almost no symptoms, she may not even o Note: some sources identify the O with “other infections”, be aware she contracted an infection. which include syphilis, HBV (HepBvirus), and HIV. Diagnosis in the mother or infant can be established by the TOXOPLASMOSIS isolation of CMV antibodies in blood serum (BLOOD CULTURE). A protozoan infection, is spread most commonly through Unfortunately, there is NO TREATMENT for the infection even if contact with uncooked meat, although it may also be it is present in the mother with enough symptoms to allow contracted through handling cat stool in soil or cat litter. detection. If the infection crosses the placenta, the infant may be born Because there is no treatment or vaccine for the disease, with CNS damage, hydrocephalus, microcephaly, intracerebral routine screening for CMV during pregnancy is not calcification, & retinal deformities. recommended. Pyrimethamine, an antifolic acid drug and an antiprotozoal o Advise women to wash hands thoroughly before eating. agent is used cautiously early in pregnancy to prevent reducing o Avoid crowds of young children at daycare or nursery folic acid levels. school settings to help prevent exposure (Drew, Stapleton, Abu, et al.,2015). RUBELLA Fetal damage from maternal infection with rubella (German HERPES SIMPLEX VIRUS (GENITAL HERPES INFECTION) measles) includes: The virus spreads into the bloodstream (viremia) and crosses 1) Deafness the placenta to the fetus. 2) Mental and motor changes 1st trimester 3) Cataracts o Congenital anomalies or spontaneous miscarriage may 4) Cardiac defects (most commonly patent ductus arteriosus occur. & pulmonary stenosis) 2nd or 3rd trimester 5) Retarded intrauterine growth (small for gestational age) o High incidence of premature birth, intrauterine growth 6) Thrombocytopenic purpura (patches of purplish retardation, & continuing infection of the newborn birth. discoloration) If genital lesions are present at the time of birth, however, a 7) Dental & facial clefts, such as cleft lip & palate fetus may contract the virus from direct exposure during birth. A woman who is not immunized before pregnancy cannot be o Cesarean birth is usually advised to reduce the risk of this immunized during pregnancy. route of infection. o Because the vaccine contains a live virus that would have This awareness of the placental spread of HSV has increased effects similar to those occurring with a subclinical case of the importance of obtaining information about exposure to rubella. HSV or any painful perineal or vaginal lesions that might After a rubella immunization, a woman is advised not to indicate this infection at prenatal visits through conscientious become pregnant for 3 months until the rubella virus is no history taking. longer active. LAMAGON | BSN 2A  CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107 CHAPTER 3: PSYCHOLOGICAL CHANGES, DANGER SIGNS, AND DISCOMFORTS Acyclovir (Zovirax) or valacyclovir (Valtrex) can both be safely E. If the infection occurs late in pregnancy administered to women who develop lesions during The infant may be born with severe anemia and pregnancy as well as to their newborns at birth (Groves, 2016). congenital heart disease (American College of o Either drug is recommended daily as prophylaxis at 36 Obstetricians and Gynecologists, 2015). weeks of pregnancy to prevent a lesion at the time of F. Lyme Disease birth. A multisystem disease caused by the spirochete Borrelia o The primary mechanism for protecting a fetus, however, is Burgdorferi, is spread by the bite of a deer tick. disease prevention. Signs/symptoms: o Urging women to practice safer sex is important to lessen 1) Erythema chronicum migrans (large, macular lesions their exposure to this and other sexually transmitted with a clear center) infections. 2) Pain in large joints OTHER VIRAL DISEASES 3) Spontaneous miscarriage A. Syphilis 4) Severe congenital anomalies Sexually transmitted infection Treatment: Treponema Pallidum cannot cross the placenta when 1) Tetracycline & doxycycline (for non-pregnant) cytotrophoblast layer of chorionic villi is still intact. 2) Penicillin (for pregnant) This layer atrophies at 16th – 18th week and treponema G. Infection that causes illness at birth pallidum can then cross the placenta and cause extensive Gonorrhea, candidiasis, chlamydia, streptococcus B, and damage. hepatitis B infections o For these reasons, serologic screening (either by a POTENTIAL TERATOGENICITY OF VACCINES venereal disease research laboratory [VDRL] or a rapid Live virus vaccines such as: plasma regain [RPR] test) is done at a first prenatal o Measles visit; o Mumps o The test may then be repeated again close to term o Rubella (the eighth month) if recent exposure is a concern. o Oral poliomyelitis (sabin type) If treated with benzathine penicillin in the 1st trimester, These are contraindicated during pregnancy because they may fetus is rarely affected. transmit the viral infection to the fetus. If left untreated beyond 18th week: TERATOGENICITY OF DRUGS o Hearing impairment 2 principles related to drug intake during pregnancy: o Cognitive challenge 1) Any drug or herbal supplement, under certain o Osteochondritis circumstances, may be detrimental to fetal welfare. o Fetal death - During pregnancy, women should not take any drug Even when a woman has been treated with antibiotics, or supplement not specifically prescribed by their the serum titer remains high up to 200 days. physician or nurse midwife. An increasing titer suggests reinfection has occurred. 2) A woman of childbearing age and ability should take no In an infant born to a woman with syphilis, the serologic drugs other than those prescribed by the physician or test for syphilis may remain positive for up to 3 months nurse midwife to avoid exposure to a drug should she even though the disease was treated during pregnancy. become pregnant. The newborn with congenital syphilis may have: TERATOGENICITY OF ALCOHOL o Congenital anomalies Alcohol is a common drug abused by women of childbearing o Extreme rhinitis (sniffles) age. Infants born to alcoholic mothers demonstrate prenatal o Characteristic syphilitic rash, all of which identify the and postnatal growth deficiency, mental retardation, and baby as high risk at birth (Akahira-Azuma, Kubota, other malformations. Hosokawa, etal., 2015). Fetuses cannot remove breakdown products of alcohol from o When the baby’s primary teeth come in, they are their body leading to vit. B deficiency and neurologic damage. often oddly shaped (i.e., Hutchinson teeth). There are subtle but classical facial features associated with As with all sexually transmitted infections, prevention fetal alcohol syndrome including short palpebral fissures, through safer sex practices is key. maxillary hypoplasia, a smooth philtrum, and congenital heart B. Rubeola (measles), coxsackievirus (human entero virus A, B, C), disease. infectious parotitis (mumps), varicella (chickenpox), Even moderate alcohol consumption consisting of 2 to 3oz. of poliomyelitis, influenza, and viral hepatitis all may be hard liquor per day may produce fetal alcohol effects. teratogenic. Women are advised to be vaccinated against influenza TERATOGENICITY OF CIGARETTES before pregnancy. Growth retardation C. If parvovirus B19, the causative agent of erythema infectiosum Sudden infant death syndrome (Pollack, 2001) (also called fifth disease) and a common viral disease in school- Low birth weight in infants of smoking mothers results from age children, contracted during pregnancy: vasoconstriction of the uterine vessels, an effect of nicotine It can cross the placenta and attack the red blood cells of that limits the blood supply to the fetus. the fetus. o Inhaled carbon monoxide is another contributing factor. D. Infection with the virus during early pregnancy o Reducing the number of cigarettes smoked per day should Associated with fetal death. help diminish adverse effects on the fetus. LAMAGON | BSN 2A  CARE OF MOTHER, CHILD, ADOLESCENT | NCM 107 CHAPTER 3: PSYCHOLOGICAL CHANGES, DANGER SIGNS, AND DISCOMFORTS ENVIRONMENTAL TERATOGENS Metal and chemical hazards o Ex: pesticides & carbon monoxide Radiation o Has been proven to be a potent teratogen to unborn children because of the high proportion of rapidly growing cells present. Hyperthermia & Hypothermia o (Hyper) may be detrimental to growth because it interferes with cell metabolism. o (Hypo) the effects are not well known. TERATOGENICITY OF MATERNAL STRESS Emotionally disturbed pregnancy, once filled with anxiety and worry beyond the usual amount could produce physiologic changes through its effect on the sympathetic division of the autonomic nervous system. Primary changes include increase in heart rate, constriction of the peripheral blood vessels, a decrease in gastrointestinal motility, & dilation of coronary blood vessels (the fight-or- flight syndrome) The constriction of uterine vessels could interfere with the blood and nutrient supply to the fetus. LAMAGON | BSN 2A