Maternal and Child Nursing Cheat Notes PDF

Maternal and Child Nursing CHEAT NOTES – Day 1 4 STRUCTURES INVOLVED IN MENSTRUAL CYCLE: 1. HYPOTHALAMUS ⎯ The release of GnRH (also called luteinizing hormone-releasing hormone [LHRH]) from the hypothalamus initiates the menstrual cycle. ⎯ GnRH then stimulates the pituitary...

Maternal and Child Nursing CHEAT NOTES – Day 1 4 STRUCTURES INVOLVED IN MENSTRUAL CYCLE: 1. HYPOTHALAMUS ⎯ The release of GnRH (also called luteinizing hormone-releasing hormone [LHRH]) from the hypothalamus initiates the menstrual cycle. ⎯ GnRH then stimulates the pituitary gland to send gonadotropic hormone to the ovaries to produce estrogen ⎯ When the level of estrogen rises, release of GnRH is repressed, and no further menstrual cycles will occur (the principle that birth control pills use to eliminate menstrual flows). Excessive levels of pituitary hormones can also inhibit release. 2. PITUITARY GLAND ⎯ It is under the influence of GnRH; the anterior lobe of pituitary gland (adenohypophysis) produces two hormones: ⎯ Follicle-stimulating hormone (FSH) = is a hormone active early in the cycle that is responsible for maturation of the ovum. ⎯ Luteinizing hormone (LH) = is a hormone that becomes most active at the midpoint of the cycle and is responsible for ovulation, or release of mature egg cell from the ovary. It also stimulates growth of the uterine lining during the second half of the menstrual cycle. ⎯ FSH and LH are called gonadotropic hormones because they cause growth (trophy) in the gonads (ovaries). 3. OVARIES (OVARIAN CYCLE) PROLIFERATIVE PHASE –from Day 1 to Day 14 of a 28-day menstrual cycle ⎯ Every month, one of the ovary’s oocytes is activated by FSH to begin to grow and mature ⎯ As the oocyte grows, its cell produces a clear fluid (follicular fluid) that contains a high degree of estrogen and progesterone. As the follicle surrounding the oocyte grows, it is propelled toward the surface of the ovary as a clear blister (Graafian follicle). ⎯ After an upsurge of LH, prostaglandins are released and the graafian follicle ruptures (ovulation) LUTEAL PHASE – from Day 15 to Day 28 of a 28-day menstrual cycle ⎯ After the ovum and the follicular fluid have been discharged from the ovary, the cells of the follicle remain in the form of a hollow, empty pit. The FSH has done its work at this point and now decrease in amount ⎯ The second pituitary hormone, LH, continues to rise in amount and directs the follicle cells left behind in the ovary to produce lutein, a bright yellow fluid high in progesterone. With lutein production, the follicle is renamed a corpus luteum (yellow body). ⎯ This happens on the 14th day before the onset of the next cycle (not the midpoint). ⎯ If conception (fertilization by a spermatozoon) occurs as the ovum proceeds down a fallopian tube and the fertilized ovum implants on the endometrium of the uterus, the corpus luteum remains throughout the major portion of the pregnancy (to about 16 to 20 weeks). ⎯ If conception does not occur, the unfertilized ovum atrophies after 4 to 5 days, and the corpus luteum remains for only 8 to 10 days. As the corpus luteum regresses, it is gradually replaced by white fibrous tissue called corpus albicans (white body). ⎯ The basal body temperature of a woman drops slightly (by 0.5O to 1OF) just before the day of ovulation because of the extremely low level of progesterone that is present at that time. It rises by 1OF on the day after ovulation because of the concentration of progesterone, which is thermogenic. ⎯ The woman’s temperature remains at this level until approximately day 24 of the menstrual cycle, when the progesterone level again decreases. 4. UTERUS (UTERINE CYCLE) ⎯ the uterus also changes monthly as a result of stimulation from the estrogen and progesterone produced by the ovaries  2 hormones that affects the cervix  Estrogen  Progesterone Uterus Estrogen – thicken the muscle (hypertrophy) Progesterone – relaxes the uterus, maintains pregnancy Upper Segment (Fundus) - Most reactive segment of the uterus - Muscles are found in all directions “figure of 8” - Upper central and posterior segment - best site for implantation of placenta Placenta Previa - Bigger placenta - Obstructs the passage way - Bleeding from the placenta o Painless  o Last trimester Lower Segment - Passive segment - Longitudinal muscles Fallopian Tube - A long as fallopian tube is healthy, fertilized egg can pass through - Isthmus o Site for tubal ligation o Estrogen – propels by rhythmic movements o Progesterone – nourishment of the zygote - Ampulla o Site of fertilization o Outer 3rd of the ampulla (distal portion) - Fibrae o Cause of ectopic pregnancy ▪ Surgery from tubal ligation, pelvic inflammatory diseases ▪ Recurrent UTI infections Pap Smear - First Papanicolaou smear – 21 years old - Earlier if sexually active (3 years after the first sexual activity) - Then annually until 3consecutive negative Paps o I – normal cells o II – abnormal cells but not malignant, suggests infection o III – abnormal cells, suggests malignancy, do cervical biopsy o IV – abnormal cells, malignancy (no biopsy) PREGNANCY Presumptive: - Subjective Data - Patient complaints - Leucorrhea, pica, pyrosis, morning sickness, quickening, urinary frequency, constipation Probable - Objective data - Positive Pregnancy test, Goodell’s, Ballottement, Chadwick’s, Hegger’s  - Increased abdominal girth - Braxton’s Hicks contraction Positive - Diagnostic - Fetal Heart (low pitch) - Fetal outline - Palpation of fetal parts Pregnancy Induced Hypertension: - At risk for PIH: Old, Smoker, with T235 Gene - Test: Roll over position o One on flat and one on side lying o Get BP o >20 diastolic – (+) hypertension - Noted on the second trimester - Manifestations: Edema – generalized anasarca, proteinuria, HTN, convulsions - Corrected after 6 weeks after delivery - Cause is unknown: due to hormonal change TORCH INFECTIONS TOXOPLASMOSIS: - Cause by parasite / protozoa - Can be ingested – infected meat of animals (not well cooked) - From droppings of animals – cat feces - From unpasteurized milk Fetal Effects - Fetal hydrocephaly - Chorioretinitis - Cerebral calcification - May cause repeated abortion Management  - Cook food very well - Antibiotics: Sulfa drug - Abortion is an option Complications - Can infect the brain Prevention - Eat only well cooked meat, no dot tough cat litter RUBELLA - Congenital rubella syndrome o Congenital cataract o Glaucoma o Microcephaly o Mental Retardation o PDA o Deafness – damage to 8th cranial nerce o IUGR - Vaccine is not given in pregnancy - Greater than 1:8 – has antibodies to rubella, has immunity - Give gamma globulin not the vaccine CYTOMEGALOVIRUS - Infection of the genital tract without symptoms - Infects the baby’s brain and damage developing bone structures - Fetal Effects: o Microcephaly o Cerebral calcification o Chorioenteritis o Hepatosplenomegaly – possible bleeding internally - Neonatal Period: o Early jaundice o Hematemesis o Melena o Hematuria o Death - Management: Antiviral (Zovirax) – not safe in early part of pregnancy - Prevention: Avoid having sex with a possible contaminated partner, monogamous relationship HERPES - Painful vesicles in the vulva and peri-anal area - Zoster – chickenpox - Simplex o Herpes Simplex I – Oral o Herpes Simplex 2 – Genital – dangerous for baby (anal and genital) - Resembles same lesions as syphilis (chancre – painless – syphilis) - Cauliflower same lesion that is painful - Has periods of remission and exacerbations - Complications – shedding the virus: direct transmission of virus to baby - Management: CS Delivery