INTRO MCHN.pdf

INTRODUCTION MATERNAL and child health nursing  Biliran province state university VISION - A state university leading in research and innovation for human empowerment and societal development. MISSION - To advance the university with innovative human resources, responsive researches, sustainab...

INTRODUCTION MATERNAL and child health nursing  Biliran province state university VISION - A state university leading in research and innovation for human empowerment and societal development. MISSION - To advance the university with innovative human resources, responsive researches, sustainable production and demand-driven extension services. Wow BIPSU - Weaves of Worthiness (WoW) for BILIRAN PROVINCE STATE UNIVERSITY  BACHELOR OF SCIENCE IN NURSING GOAL - To provide quality and globally competitive professional nursing education through integrating professional values, ethics, and standards of nursing practice with caring at the core. INSTITUTIONAL OUTCOMES - A globally competitive State University imbued with positive values, and contributory to sustainable development and progress. ► PROGRAM OUTCOME - Provide safe, appropriate & holistic care to individuals, families, population groups, and ► community utilizing the nursing process; ► Communicate effectively in speaking, writing and presenting using culturally appropriate language in conducting health education, assessment, diagnosing and documentation; ► Work effectively in collaboration with inter-intra-and multi-cultural teams in the delivery of nursing care; ► Update skills and knowledge in nursing care through the pursuit of continuing nursing education, trainings and seminars; ► Integrate the use of modern technology such as in the care for patients both in the community and clinical settings. ► Practice appropriate corrective actions to prevent or minimize harm arising in nursing care in accordance with existing laws, legal, ethical and moral principles; ► Manage the delivery of nursing care based on a participatory approach on clinical, client and nurse safety and customer care standards; ► Provide nursing care interventions based on the Philippine nursing law and other legal regulatory requirements relevant to safe nursing practice; ► Provide safe, quality and professional nursing care adhering to ethico-legal considerations; ► Craft guidelines and principles thru evidence-based practice in the delivery of care; ► Conduct research with an experienced researcher on identified existing health needs and ► problems; ► Document to include reporting up to date client care accurately and comprehensively; ► Manage the principles and concepts of human behaviour in the delivery of various nursing care; ► Use strategic entrepreneurial interventions to address health issues and concerns on any health ► Care setting  GRADING SYSTEM: THEORY 70% RLE 30% Skills Lab 70% Clinics 30% Criteria % Criteria % Criteria % Written Requirements Term Examination (Midterm & Final) Term Exams - Hospital Requirements - Objective – Type Examination 40% - Objective-Type Examination 40% - Case Studies 30% - OR/DR Forms (Multiple Choice) - Practical Exam - Portfolio Skills Performance Worksheets - Clinical Feedback Evaluation - Case Analysis Sheets 15% Return Demo/NCP 20% - Patients Feedback Evaluation 35% - Staff Nurse/Supervisor Rating - Journal Review, Reflection Essays, notes - Group Report Quizzes - Chapter Test 30% Quizzes 25% Achievement Test 20% - Pre-Test & Post Test Written Requirements Attitude Oral Revalida (with standard rubrics) 15% - Case Analysis 15% 15% - Group/Individual Report - Personal & professional ethics TOTAL 100% TOTAL 100% TOTAL 100%  PRACTICAL EXAM Criteria Percentage Knowledge 1. Able to state the rationale of each performed 2. Able to prioritize the nursing interventions performed based from the scenarios given. 40% 3. Able to describe the use of each materials/equipment prepared. 4. Able to prepare all the materials needed during the conduct of the nursing procedure. Skills 1. Able to use therapeutic communication. 2. Able to perform the procedure accurately. 3. Use body mechanics in any nursing procedure. 35% 4. Observes sterile techniques needed 5. Applies universal precaution in all procedures. Attitude 1. Applies the ethico-moral considerations. 2. Accepts criticism positively. 25% 3. Resourcefulness. 4. Showed alertness and responsiveness on the given scenario. TOTAL 100% ► PRE- ASSESSMENT QUIZ: 1. What is the major focus of nursing practice in Maternal and Child Nursing Health Practice? 2. What is the nurses role in child bearing and child raring families? 3. What are the philosophies of MCHN? 4. What is Evidence- Based practice? 5. What is Health promotion? 6. What is health maintenance? 7. What is health restoration? 8. What is health rehabilitation? 9. Enumerate the 17 sustainable Development Goals?  Goals and Philosophies of Maternal and Child Health Nursing ► The primary goal of maternal and child health nursing care can be stated as the promotion and maintenance of optimal family health to ensure cycles of optimal childbearing and childrearing. - Preconceptual health care - Care of women during 3 trimesters of pregnancy and puerperium - Care of children during the perinatal period - Care of children from birth through adolescence - Care in settings as varied as the birthing room, the pediatric intensive care unit, and the home.  Philosophy of MCHN: ► family centered ► community centered ► Research oriented ► evidence based ► serves as an advocate to protect the rights ► high degree of independent nursing functions ► Promoting health and disease prevention ► Pregnancy or childhood illness can be stressful and can alter family life in both subtle and extensive ways ► Personal cultural and religious attitudes and beliefs influence the meaning of the illness and its impact on the family. ► Maternal and child health nursing is a challenging role for a nurse and is major factor in promoting health and wellness  Standards of Maternal and Child Health Nursing Practice Professional Performance: ANA/SOCIETY PEDIATRIC - Quality of care - Performance appraisal - Education - Collegiality - Ethics - Research - Resource utilization :WOMENS HEALTH, OBSTETRIC, AND NEONATAL - Quality of care - ethics - practice environment - Performance appraisal - collaboration - accountability - Education -research - Collegiality - resource utilization  A FRAMEWORK FOR MATERNAL AND CHILD HEALTH NURSING CARE Maternal and child health nursing can be visualized within a framework in which nurses, using nursing process, nursing theory, and evidence-based practice, care for families during childbearing and childrearing years through four phases of health care: ► Health promotion ► Health maintenance ► Health restoration ► Health rehabilitation NURSING PROCESS- the systematic problem solving method licensed nurses use when they provide nursing car Theories Related to Maternal and Child Nursing Theorist Major Concepts Patricia Benner Nursing is caring Dorothy Johnson Subsystems that must remain in balance Imogene King Process of action, reaction, interaction and transaction Madeleine Leininger The essence of nursing care Florence Nightingale Changing or structuring elements of environment Betty Neuman Open system that interacts with the environment Dorothea Orem Focus is on individual, in terms of ability to complete self care Ida Jean Orlando Interaction with the client effectiveness of care depends on clients behavior Rosemarie Rizzo Parse Nursing is a human science Hildegard Peplau Forward movement of the personality Martha Rogers Move the client toward optimal health Sister Callista Roy Adapt to the change Roles and Responsibilities of a Maternal Child Nurse ► Clinical nurse specialists ► Case manager ► Women’s health nurse practitioner ► Family nurse practitioner ► Neonatal nurse practitioner ► Pediatric nurse practitioner ► Nurse- midwife  Evidenced – Based Practices in Maternal and Child Nursing ► use of research or controlled investigation of a problem with clinical expertise as a foundation for action. ► Provides the justification for implementing activities for outcome achievement, resulting in improved and cost-effective patient care. ► 3 components of EBP – RESEARCH, CLINICAL EXPERTISE PATIENT VALUES ► 5 steps of EBP - converting the need for information into answerable questions - Tracking down the best evidence - Critically appraising evidence for its validity, impact and applicability - Integrating the critical appraisal with clinical expertise and patients uniqueness - Evaluating effectiveness and efficiency Reproductive and Sexual Health REPRODUCTIVE and SEXUAL HEALTH Anatomy and Physiology of Female/ Male Reproductive System ► Female Reproductive System The female reproductive system, like the male system, has both external and internal components (Anderson & Genadry, 2007). Female External Structures The structures that form the female external genitalia are termed the vulva (from the Latin word for “covering”). FEMALE EXTERNAL PART: ► Mons Veneris. ► Labia Minora. ► Labia Majora. ► The vestibule ► The clitoris ► Bartholin’s glands (vulvovaginal glands) ► The fourchette ► Vulvar Blood Supply. ► Vulvar Nerve Supply. Internal part : ovaries, fallopian tubes, uterus Psychosexual theory of Sigmund Freud  REPRODUCTIVE DEVELOPMENT ► Reproductive development and change begin at the moment of conception and continue throughout life. Intrauterine Development The sex of an individual is determined at the moment of conception by the chromosome information supplied by the particular ovum and sperm that joined to create the new life. ► A gonad is a body organ that produces the cells necessary for reproduction (the ovary in females, the testis in males). At approximately week 5 of intrauterine life, primitive gonadal tissue is already formed. In both sexes, two undifferentiated ducts, the mesonephric (wolffian) and paramesonephric (müllerian) ducts, are present. By week 7 or 8, in chromosomal males, this early gonadal tissue differentiates into primitive testes and begins formation of testosterone. Under the influence of testosterone, the mesonephric duct begins to develop into the male reproductive organs, and the paramesonephric duct regresses. If testosterone is not present by week 10, the gonadal tissue differentiates into ovaries, and the paramesonephric duct develops into female reproductive organs. All of the oocytes (cells that will develop into eggs throughout the woman’s mature years) are already formed in ovaries at this stage (MacKay, 2009). At about week 12, the external genitals develop. In males, under the influence of testosterone, penile tissue elongates and the urogenital fold on the ventral surface of the penis closes to form the urethra; in females, with no testosterone present, the urogenital fold remains open to form the labia minora; what would be formed as scrotal tissue in the male becomes the labia majora in the female. If, for some reason, testosterone secretion is halted in utero, a chromosomal male could be born with female-appearing genitalia. If a woman should be prescribed a form of testosterone during pregnancy or if the woman, because of a metabolic abnormality, produces a high level of testosterone, a chromosomal female could be born with maleappearing genitalia (Torresani & Biason-Lauber, 2007). ► Pubertal Development Puberty is the stage of life at which secondary sex changes begin. These changes are stimulated when the hypothalamus synthesizes and releases gonadotropin-releasing hormone (GnRH), which in turn triggers the anterior pituitary to begin the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH initiate the production of androgen and estrogen, which in turn initiate secondary sex characteristics, the visible signs of maturity. Girls are beginning dramatic development and maturation of reproductive organs at earlier ages than ever before (9 to 12 years) (McDowell, Brody, & Hughes, 2007). Although the mechanism that initiates this dramatic change in appearance is not well understood, the hypothalamus, under the direction of the central nervous system, may serve as a gonadostat or regulation mechanism set to “turn on” gonad functioning at this age. Although it is not proved, the theory is that a girl must reach a critical weight of approximately 95 lb (43 kg) or develop a critical mass of body fat before the hypothalamus is triggered to send initial stimulation to the anterior pituitary gland to begin the formation of gonadotropic hormones. Studies of female athletes and girls with anorexia nervosa reveal that a lack of fat can delay or halt menstruation. The phenomenon of why puberty occurs is even less well understood in boys ► Role of Androgen Androgenic hormones are the hormones responsible for muscular development, physical growth, and the increase in sebaceous gland secretions that causes typical acne in both boys and girls. In males, androgenic hormones are produced by the adrenal cortex and the testes; in females, by the adrenal cortex and the ovaries. The level of the primary androgenic hormone, testosterone, is low in males until puberty (approximately age 12 to 14 years). At that time, testosterone levels rise to influence the further development of the testes, scrotum, penis, prostate, and seminal vesicles; the appearance of male pubic, axillary, and facial hair; laryngeal enlargement and its accompanying voice change; maturation of spermatozoa; and closure of growth in long bones. In girls, testosterone influences enlargement of the labia majora and clitoris and formation of axillary and pubic hair. This development of pubic and axillary hair because of androgen stimulation is termed adrenarche. ► Role of Estrogen When triggered at puberty by FSH, ovarian follicles in females begin to excrete a high level of the hormone estrogen. This hormone is actually not one substance but three compounds (estrone [E1], estradiol [E2], and estriol [E3]). It can be considered a single substance, however, in terms of action. The increase in estrogen levels in the female at puberty influences the development of the uterus, fallopian tubes, and vagina; typical female fat distribution and hair patterns; breast development; and an end to growth because it closes the epiphyses of long bones. The beginning of breast development is termed thelarche. Secondary Sex Characteristics : Adolescent sexual development is categorized into stages (Tanner, 1990). 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 are manifest as: ► 1. Growth spurt ► 2. Increase in the transverse diameter of the pelvis ► 3. Breast development ► 4. Growth of pubic hair ► 5. Onset of menstruation ► 6. Growth of axillary hair ► 7. Vaginal secretions Secondary sex characteristics of boys usually occur in the order of: ► 1. Increase in weight ► 2. Growth of testes ► 3. Growth of face, axillary, and pubic hair ► 4. Voice changes ► 5. Penile growth ► 6. Increase in height ► 7. Spermatogenesis (production of sperm)  Reproductive and Sexual Health ► Amenorrhea – absence of menses ► Menstruation- shedding of blood, mucus and tissues from internal lining of the uterus ► Dysmenorrhea – painful, difficult menstruation ► Menarche – the beginning of menstruation ► Menopause – decline in reproductive potential in females; cessation of menses ► Menorrhagia – excessive menstruation ► Metrorrhagia – bleeding in between menses ► Ovulation – monthly release of a mature ovum from an ovary ► sexual orientation – a dynamic expression of a person’s preference for sexual relationship ► Thelarche – breast development ► Fertility – the potential of a man or woman to reproduce ► Infertility – failure to conceive after a regular frequency of sexual intercourse without contraception ► Secondary Infertility – failure to conceive after a previous successful pregnancy ► Gynecomastia – temporary increase in breast size in male  MENSTRUAL CYCLE: ► STRUCTURES AND HORMONES INVOVED IN THE MENSTRUAL CYCLE: STRUCTURES HORMONE Hypothalamus gonadotropin hormones (GnRH) Pituitary gland follicle stimulating hormone(FSH)& Luteinizing hormone(LH) Ovaries estrogen & Progesterone PHASES OF THE MENSTRUAL CYCLE: 1. PROLIFERATIVE- endometrium begins proliferate, growth is very rapid; increases the thickness to approximately 8 folds, increase continues for 1 half of menstrual cycle termed as estrogenic, follicular or postmenstrual phase st 2. SECRETORY- increase in estrogen receptor content, formation of progesterone in the corpus luteum of the ovary gland causes it to become twisted in appearance and dilated with quantities of glycogen and mucin, termed as progestational, luteal, premenstrual phase. 3. ISCHEMIC- if (-) fertilization, the corpus luteum in the ovary begins to regress after 8-10 days, progesterone estrogen production regresses, withdrawal of progesterone stimulation causes the endometrium to degenerate. 4. MENSES- capillaries rupture with minute minute hemorrhages, endometrium sloughs off, discharges from the uterus: blood( from ruptured capillaries), mucin from glands fragments of endometrial tissue and microscopic atrophied and unfertilized ovum. - SEXUAL RESPONSE CYCLE: 1. EXCITEMENT- rapid erection of penis in men and clitoral enlargement and vaginal lubrication in women 2. PLATEAU- cowper gland releases fluids with continuous enlargement and thickening of the penis in men, while full elevation of uterus with concurrent rising of cervix in females. 3. ORGASM- climatic expulsive contraction of the entire urethra with ejaculation in men, and orgasmic platform 4. RESOLUTION- which is the return to pre arousal states in both sexes. ► Characteristics of Normal Menstrual flow: Menarche Average age onset is 11-13 years and average range is 9-17 years Interval between cycles Average is 28 days; cycles of 23-25 days are not usual Duration of menstrual flow Average flow is 2-7 days; range of 1-9 days are not abnormal Amount of menstrual flow Difficult estimate; average of 30-80ml per menstrual period; saturating a pad or tampon in less than an hour is heavy bleeding Color of menstrual flow Dark red; combination of blood, mucus and endometrial cells odor Similar to that of marigolds ► Education for Menstruation: - Exercise - Sexual relations - Activities of daily living - Pain relief - Rest - nutrition ► KEY TERMS: PRIMIPARA- is a woman who has completed one pregnancy with a fetus that reached the age of viability NULLIGRAVIDA- refers to a woman who has never been pregnant. PARITY – refers to the number of past pregnancies that has reached period of viability(possibility of survival outside the uterus, after 24 weeks gestation) TERM- refers to age of gestation of 38 to the end of 42 weeks of pregnancy. FHR- is a significant indicator of fetal well-being. Its is heard below the mothers umbilicus. CHADWICKS- bluish discoloration of vaginal wall HEGAR – softening of lower uterine segment UTERINE ENLARGEMENT- at 12 weeks gestation felt just above symphysis pubis POSITIVE PREGNANCY TEST- presence of gonadotropin in urine BALLOTTMENT- sinking and rebound of fetus GOODELLS- softening of the cervix BRAXTON HICKS CONTRACTION- painless contraction at 28 weeks Primigravida- a woman in her first pregnancy Multipara - (a woman who has had one or more children) Linea nigra- narrow, brown line may form, running from the umbilicus to the symphysis pubis and separating the abdomen into right and left hemispheres Melasma (chloasma)- or the “mask of pregnancy. Para -Number of pregnancies that have reached viability, regardless of whether the infants were born alive Gravida -Woman who is or has been pregnant Multipara -Woman who has carried two or more pregnancies to viability Lithotomy position -(on her back with her thighs flexed and her feet resting in the examining table stirrups) GTPALM T: Number of full-term infants born (infants born at 37 weeks or after) P: Number of preterm infants born (infants born before 37 weeks) A: Number of spontaneous miscarriages or therapeutic abortions L: Number of living children M: Multiple pregnancies PREGNANCY: ► PERIODS OF PREGANCY: - 1ST TRIMESTER ( 1-3 mos.) - 2ND TRIMESTER (4 -6mos.) - 3RD TRIMESTER ( 7-9mos) DURATION OF PREGNANCY: - DAYS ( 267-280) - WEEKS (40) - LUNAR MONTHS ( 10) - CALENDAR MONTHS ( 9) - TRIMESTERS (3) COMMON PSYCHOSOCIAL CHANGES that occur in PREGNANCY: ► 1 ST TRIMESTER- ACCEPTING THE PREGNANCY ► 2 ND TRIMESTER – ACCEPTING THE BABY ► 3 RD TRIMESTER- PREPARING FOR THE BABY AND END OF PREGNANCY -EVENTS THAT COULD CONTRIBUTE TO DIFFICULTY ACCEPTING THE PREGNANCY: Learning that the pregnancy is a multiple one Learning that the fetus has a developmental abnormality Pregnancy less than 1 year after a previous one Relocation during pregnancy (involves a need to find new support people) Moving away from the family or back to the family for economic reasons Role reversal (a previously supporting person who becomes dependent, or vice versa) Job loss Marital infidelity Illness in self, husband, or a relative Loss of a significant other Complications of pregnancy such as severe hypertension Having friends or relatives who have had children born with health disorders ► EMOTIONAL RESPONSES TO PREGNANCY: - GRIEF - NARCISSISM - INTROVERSION VS. EXTROVERSION - BODY IMAGE AND BOUNDARY - STRESS - COUVADE SYNDROME - CHANGES IN SEXUAL DESIRE - EMOTIONAL LABILITY  DIAGNOSIS IN PREGNANCY PRESUMTIVE PROBABLE POSITIVES (SIGNS & SYMPTOMS FELT BY (CHANGES OBSERVED BY THE ( DEFINITIVE SIGN OF - WOMAN) EXAMINER) PREGNANCY) BREAST CHANGES(2wks) SERUM LABORATORY TEST(1wks) EVIDENCE ON ULTRASOUND OF FETAL OUTLINE(8wks) NAUSEA, VOMITING(2wks) CHADWICKS SIGN(6wks) FETAL MOVEMENT FELT BY EXAMINER(8wks) AMENORRHEA(2wks) GOODELL’S SIGN, HEAGR SIGNS FETAL HEARTH BEAT(10-12wks) (6wks) FREQUENT URINATION( 3wks) EVIDENCE ON ULTRASOUNS OF GESTATIONAL SAC(6wks) FATIGUE( 12 wks) BALLOTTEMENT(6wks) QUICKENING( 18-20wks) BRAXTON HICKS CONTRACTIONS(20wks) LINEA NIGRA, MELASMA, STRIAE FETAL OUTLINE FELT BY GRAVIDARUM ( 24wks) EXAMINER(20wks) CARE OF FETUS ► STAGES OF FETAL DEVELOPMENT CARE OF FETUS ► FERTILIZATION: -per ejaculation the average seminal fluid is 2.5ml containing 50 to 200 million spermatozoa per ml 400million per ejaculation -fertilization occurs in the outer third( ampulla portion) of the fallopian tube. - a woman’s ova will reach maturity each month. - Once the mature ovum is released, fertilization must occur fairly quickly because an ovum is capable of fertilization for only 24 hours (48 hours at the most) - HYALURONIDASE is released by the spermatozoa dissolves the layer of cells protecting the ovum, facilitating the penetration of the spermatozoon. - Upon fertilization, the resulting structure is called ZYGOTE - Only the father can determine the gender of the child –X- carrying spermatozoon leads to XX combination for a female offspring; Y –carrying spermatozoon leads to XY combination for male offspring. The ovum carries X chromosome. - IMPLANTATION-Contact between the growing structure and the uterine endometrium, occurs approximately 8 to 10 days after fertilization. TERMS USED TO DENOTE FETAL GROWTH CONCEPTUS: PERIOD: OVUM FROM OVULATION TO FERTILIZATION ZYGOTE FROM FERTILIZATION TO IMPLANTATION EMBRYO FROM IMPLANTATION TO 5-8WEEKS FETUS FROM 5-8WEEKS TO TERM FETAL CIRCULATION STRUCTURE LOCATION FUNCTION PLACENTA ATTACHED TO THE UTERUS GAS EXCHANGE DURING FETAL LIFE UMBILICAL ARTERIES 2 ARTERIES IN THE CORD CARRY OXYGENATED BLOOD FROM THE FETUS(DESCENDING AORTA) TO THE PLACENTA UMBILICAL VEIN ONE VEIN IN THE CORD CARRY OXYGENATED BLOOD TO THE FETUS FORAMEN OVALE OPENING IN THE INTERRATIAL SEPTUM TO SHUNT BLOOD FROM THE RIGHT ATRIUM TO THE LEFT ATRIUM SO THAT BLOOD CAN BE SUPPLIED TO BRAIN , HEART AND KIDNEY DUCTUS VENOSUS ACCESSORY VEIN CONNECTING UMBILICAL VEIN TO SUPPLY BLOOD TO THE LIVER. A BYPASS TO INTO FETAL LIVER ANF INFERIOR VENA CAVA THE FETAL LIVER DUCTUS AETERIOSUS CONNECTION BETWEEN FETAL LUNGS AND THE SHUNTING OF THE LARGER PORTION OF THE AORTA BLOOD WAY FROM THA LUNGS AND DIRECTLY INTO THE AORTA SIGNS & SYMTOMPS OF PREGNANCY: 1. PRESUMPTIVE SYMPTOMS ( SUBJECTIVE EVIDENCE) 2. PROBABLE SIGNS ( OBJECTIVE EVIDENCE) 3. POSITIVE SIGNS (ABSOLUTE EVIDENCE) - MATERNAL PHYSIOLOGY DURING PREGNANCY: 1. UTERUS – ENLARGEMENT AND THICKENING(HYPERTROPHY)(AT LEVEL OF UMBILICUS BY 20TH WEEKS AOG) 2. CERVIX –SOFTENING AND CYANOSIS 3. OVARIES- OVULATION IS CEASES 4. VAGINA – SECRETIONS INCREASES; Ph 3.5.6, CHADWICK’S SIGN 5. BREAST – TENDER AND TINGLE, INCREASE IN SIZE, COLOSTRUM 6. STRIAE GRAVIDARUM – REDDISH, DEPRESSED STREAKS IN ABDOMINAL WALL,BREAST & THIGH 7. CHLOASMA – 8. WEIGHT GAIN – AVERAGE IS 11-13KGS. (24-28 LBS) FETUS ( 3400GM), PLACENTA ( 450GM), AMNIOTIC FLUID (900GM), UTERUS (1GM) BREAST TISSUE ( 1400GM), BLOOD VOLUME (1800GM) 9. WATER METABOLISM – 6.5 liters of extra water during pregnancy 10. PROTIEN METABOLISM – FETUS, UTERUS AND MATERNAL BLOOD ARE RICH IN PROTIEN 11. CARBOHYDRATE METABOLISM 12. FAT METABOLISM 13. IRON METABOLISM 14. PLACENTA PITUITARY 15. HEART 16. CIRCULATION 17. HEMATOLOGIC 18. VENTILATION 19. DIAPHRAGM 20.THORACIC CAGE 21. URETERS 22. GFR COMMON DISCOMFORTS OF PREGNANCY: ► ANKLE EDEMA ► BACK ACHE ► BREAST TENDERNESS ► CONSTIPATION ► DYSPNEA ► DIFFICULTY SLEEPING ► FATIGUE ► HEART BURN ► HEMORRHOIDS ► LEG CRAMPS ► LEUKORRHEA ► NAUSEA ► NAUSEA ► NASAL STUFFINESS ► PICA ► PTYALISM ► URINARY FREQUENCY ► VARICOSE VEINS PRENATAL VISITS Prenatal care is the health care you get while you are pregnant. It includes your checkups and prenatal testing. Prenatal care can help keep you and your baby healthy. It lets your health care provider spot health problems early. Early treatment can cure many problems and prevent others - EXERCISE DURING PREGNANCY: ► PELVIC TILT ► TAILOR-SITTING ► SQUATTING ► KEGEL’S EXERCISE - IMMUNIZATION DURING PREGNANCY: TT1- AS EARLY AS POSSIBLE DURING PREGNANCY TT2 – AT LEAST 4 WEEKS LATER TT3 – AT LEAST 6 MONTHS LATER - SCHEDULE OF CLINIC VISITS : 1ST VISIT – AS PREGNANCY IS SUSPECTED ONCE A MONTH UP TO 32 WEEKS TWICE A MONTHS( EVERY 2 WEEKS )FROM 32 TO 36 WEEKS FOUR TIMES A MONTHS (EVERY WEEK )FROM 36- 40 WEEKS MEASUREMENTS IN A PRENATAL VISIT: ► CBC ► EDEMA CHECK ► FHT ► FUNDIC HEIGHT ► HEIGHT ► LEOPOLD’S MANEUVER ► PELVIC ADEQAUCY EXAMINATION ► UE ► VITAL SIGNS ► WEIGHT  DETERMINING THE DUE DATE/EDC & AOG ► NAGELE’S RULE – 1ST DAY OF THE LAST MENSTRUATUAL PERIOD (LMP). THEN SUBTRACT 3 MONTHS, ADD 7 DAYS TO THE FIRST DAY OF LMP, AND ADD 1 YEAR. Example: 1st day of LMP: SEPTEMBER 16, 2010 Subtract 3 months = June 16 add 7 days= June 23 add 1 year = June 23, 2011 is the expected date of confinement EXAMPLE: LMP : December 16,2012 12 16 2012 3 +7 +1 ________________________ 9 23 2013 DETERMINING THE AOG: ❑ Number of days since LMP to the present day divided by 7 Example: A pregnant woman comes to the clinic for an initial prenatal check up. Her LMP was December 16, 2012. Present day is February 14,2013.  LMP December – 16 ( 31 days - 16 days = 15 DAYS ) January – 31 February- 14 ______________ 60 days/7 = 8 weeks and 5 days AOG. Mc DONALD METHOD Formula: AOG (months) = fundic height in cm) divide it by 4 Example: FH :24 24/4 = 6 months For 20 weeks AOG and above FH (cm)/4 = AOG (weeks) For below 20 weeks AOG FH (CM) X 8 / 7 = AOG in weeks BARTHOLOMEW’S RULE ► Estimates the AOG by the relative position of the uterus in the abdominal cavity. MODULE 2 LESSON 2: INTRAPARTAL CARE  THEORIES OF LABOR: ► Uterine muscle stretching, which results in release of prostaglandins ► Pressure on the cervix, which stimulates the release of oxytocin from the posterior pituitary ► Oxytocin stimulation, which works together with prostaglandins to initiate contractions ► Change in the ratio of estrogen to progesterone (increasing estrogen in relation to progesterone, which is interpreted as progesterone withdrawal) ► Placental age, which triggers contractions at a set point ► Rising fetal cortisol levels, which reduces progesterone formation and increases prostaglandin formation ► Fetal membrane production of prostaglandin, which stimulates contractions SIGNS OF LABOR ► Preliminary Signs of Labor: - Lightening : primiparas, lightening, or descent of the fetal presenting part into the pelvis, occurs approximately 10 to 14 days before labor begins. - Increase in Level of Activity : A woman may awaken on the morning of labor full of energy, in contrast to the feeling of chronic fatigue she felt during the previous month. This increase in activity is related to an increase in epinephrine release initiated by a decrease in progesterone produced by the placenta. - Slight Loss of Weight: As progesterone level falls, body fluid is more easily excreted from the body. This increase in urine production can lead to a weight loss between 1 and 3 pounds. - Braxton Hicks Contractions: In the last week or days before labor begins, a woman usually notices extremely strong Braxton Hicks contractions. - Ripening of the Cervix : is an internal sign seen only on pelvic examination. Throughout pregnancy, the cervix feels softer than normal to palpation, similar to the consistency of an earlobe (Goodell’s sign). At term, the cervix becomes still softer (described as “butter-soft”), and it tips forward. Cervical ripening this way is an internal announcement that labor is very close at hand. ► Signs of True Labor: - Uterine Contractions : The surest sign that labor has begun is productive uterine contractions. Because contractions are involuntary and come without warning. - Show As the cervix: softens and ripens, the mucus plug that filled the cervical canal during pregnancy (operculum) is expelled. - Rupture of the Membranes: Labor may begin with rupture of the membranes, experienced either as a sudden gush or as scanty, slow seeping of clear fluid from the vagina. ► COMPONENTS OF LABOR: 1. A woman’s pelvis (the passage) is of adequate size and contour. 2. The passenger (the fetus) is of appropriate size and in an advantageous position and presentation. 3. The powers of labor (uterine factors) are adequate. (The powers of labor are strongly influenced by the woman position during labor.) 4.. A woman’s psychological outlook is preserved, so that afterward labor can be viewed as positive experience.