maternity 1 (inc).pdf

CARE OF MOTHER, CHILD, AND ADOLESCENT NCM 107 - MATERNAL | BSN2H | FIRST SEMESTER | CHICA MONS PUBIS – thick fold of fats; front or above the ISTHMUS – lower uterine segment (LUS); site of cesarian symphysis pubis. section. ESCUTCHEON – me...

CARE OF MOTHER, CHILD, AND ADOLESCENT NCM 107 - MATERNAL | BSN2H | FIRST SEMESTER | CHICA MONS PUBIS – thick fold of fats; front or above the ISTHMUS – lower uterine segment (LUS); site of cesarian symphysis pubis. section. ESCUTCHEON – medical term for pubic hair. CERVIX – effacement = softening of cervix during labor; dilatation = widening of diameter of cervix. EXTERNAL STRUCTURE (FEMALE ȫ Prostaglandin – cause of effacement and dilatation. REPRODUCTIVE SYSTEM) FALLOPIAN TUBE – tube where the eggs flow from the ovaries to uterus. LABIA MAJORA – made of adipose tissue; thick fold of adipose tissue. FOUR TYPES OF FALLOPIAN TUBE − hairy, moist (dry if menopause) i. ISTHMUS – narrowest portion; site of bilateral tubal ȫ Anterior commissure – border of labia majora and ligation. mons pubis. ii. INTERSTITIAL – most proximal part ȫ Posterior commissure iii. AMPULLA – longest portion of fallopian tube; site of LABIA MINORA – too thin; thin fold of adipose tissue fertilization. − highly vascular; with blood vessels iv. INFUNDIBULUM – most distant ȫ Anterior commissure – prefuse (edge) ȫ Posterior commissure – fourchette (edge) FUNCTIONS OF FALLOPIAN TUBE CLITORIS – seat of female arousal; most sensitive part of i. Transport of ovum female external reproductive structure ii. Site of fertilization − guide for catheterization iii. Nourishment of ovum URETHRAL MEATUS – passageway of urine; below clitoris SMEGMA – cheese-like structure OVARIES – small, oval-shaped glands; produce and store VESTIBULE – part between two labia minora; holes of vulva. eggs. − 6 holes of vulva: ȫ Oogonia – immature egg cells ȫ Skene’s gland – two holes (minor vestibular); beside ȫ Oocyte – mature egg cells urethral meatus ȫ Bartholin’s gland – 2 holes (major vestibular); paravaginal and vulvovaginal ° 2 months intrauterine = 600k ° Child to adult – 300k – 400k oogonia ° 36 y/o = 30k – 40k TRIVIA: Grafenberg spot or “g spot” is much more sensitive ° 5 months intrauterine = 6-7 million ° Menopause – 0 than clitoris; 1 to 2 inches away from outside of vulva; inner oogonia anterior portion of vulva. ° At birth = 2 million oocytes HYMEN – separate internal from external; “gate” FUNCTIONS OF OVARIES i. Hormone production TRIVIA: “Female are more likely to have UTI bcs they have ii. Oogenesis (production of egg cells) shorter urethral compared to male”. iii. Ovulation INTERNAL STRUCTURE (FEMALE ANALOGOUS STRUCTURE REPRODUCTIVE SYSTEM) FEMALE MALE VAGINA – hollow muscular (stretchable) canal ° Ovum ° Sperm − behind the bladder; front of rectum. ° Clitoris ° Glands penis CUL-DESAC DOUGLAS – space between rectum and vagina ° Labia majora ° Scrotum ȫ pre-puberty = alkaline ° Vagina ° Penis ȫ post-puberty = acidic ° Ovaries ° Testes ȫ Doderlein bacilli – maintains acidity of vagina ° Fallopian tube ° Vas deferens NOTE: (1) female sperm cells survive in an acidic ° Skene’s gland ° Prostate gland environment; (2) pregnant = slightly alkaline ° Bartholin’s gland ° Cowper’s gland PROSTATE GLAND & COWPER’S GLAND – releases PURPOSE/FUNCTION OF VAGINA seminal fluid. SEMINAL FLUID – pool of sperm; pH = alkaline i. Birth control ° Sperm + Seminal fluid = semen ii. Organ of copulation SCROTUM – one degree celcius cooler than body temp. iii. Passage of menstruation SPERMATOGENESIS – production of sperm cells UTERUS – pear-like shape; 60 grams; 17 y/o = maximum size is reached. MENSTRUATION TWO STAGES PURPOSE/FUNCTION OF UTERUS i. Follicular (estrogen) i. Organ of menstruation, contraction, and ii. Luteal (progesterone) reproduction. FOUR PHASES THREE LAYERS OF UTERUS i. Menstrual – 1 to 5 days i. PERIMETRIUM – serosal layer; outer ii. Proliferative – 6 to 13 days ii. MYOMETRIUM – muscular layer iii. Secretory – 15 to 23 days iii. INDOMETRIUM – inside/mucosal; basal layer and iv. Ischemic – 24 to 28 days glandular layer OVULATION – 14TH day from follicular day of menses FUNDUS – placental implantation (most composite) (backwards) − most contract tile portion; strongest part of uterus. − no. of days of follicular = varies CORNUA – attachment of fallopian tube − no. of days of ovulation = constant CARE OF MOTHER, CHILD, AND ADOLESCENT NCM 107 - MATERNAL | BSN2H | FIRST SEMESTER | CHICA TAKE NOTE: In the four phases, proliferative comes first. FUNCTIONS OF PROGESTERONE PHASE ORDER: proliferative – secretory – ischemic – i. Inhibits follicle stimulating hormone menstrual ii. Thermogenic – high basal body temperature iii. Relaxes urine muscle MENSTRUAL PHASE iv. Pre-menstrual syndrome v. Fullness of breast why vi. Development of Acinar Structure of Breast E & P (low estrogen and progesterone) menstruation ° ACINAR CELLS – produces milk exist vii. Releases milk production Cause endometrium to shed off MAJOR SIGNS OF OVULATION ✓ Spinnbarkeit ✓ Mittelschmerz – abdominal pain Menses Function of P – relaxation of uterine muscles ✓ Increase basal body temperature ✓ Increase blood level of luteinizing hormone MENSTRUAL DISORDERS PROLIFERATIVE PHASE DYSMENORRHEA – painful menstruation AMENORRHEA – absence of mens (old, young, pregnant) E (low estrogen) Anterior pituitary gland OLLIGOMENORRHEA – low volume of menses POLYMENORRHEA – high frequency of menses To release follicle MENORRHAGIA – heavy and prolong menses Hypothalamus will stimulating hormone ovaries METRORRHAGIA – bleeding in between menses release FSHRF (follicle stimulating hormone releasing factor) Responsible for development MENOPAUSE of graafian follicle produces and Average – 51 y/o increases estrogen. Usually – 45 to 55 y/o Women of reproductive age (WRA) – 15 to 49 y/o SYMPTOMS: SECRETORY PHASE ȫ Hot flushes ȫ Mood swings P (low progesterone) ȫ Atrophy of secondary sexual characteristics ȫ Frequent heat Hypothalamus will release Corpus luteum – sperm reaches ȫ Osteoporosis (pregnant); fallopian tube (ampulla); LHRF (luteinizing hormone life span = 7-9 days releasing factor) MANAGEMENT: ȫ Take a bath; aircon ȫ Estrogen replacement therapy Ovaries will develop Anterior pituitary to release graafian follicle (1) will rupture (ovulation) – can ȫ Calcium and Vitamin D luteinizing hormone be pregnant within 7-9 days; (2) corpus luteum = release P&E FETAL DEVELOPMENT PROCESS OVUM – female sex cells; life span: 24-36 hours. ISCHEMIC PHASE SPERM – male sex cells; life span: 48-72 hours NOTE: (1) Gymnosperm – female (23x); (2) Androsperm – No fertilization male (23y); (3) Fetus – 46xy (composed of 22 pairs autosome + 1 pair sex chromosome) Corpus luteum dies FETAL FORMATION INSEMINATION − semen goes to female reproductive system NOTE: Blastocyst will rise to None to produce estrogen & progesterone − 90 seconds in uterus; amnion to chorion − 5 minutes in fallopian tube AMNION – amniotic GRAAFIAN FOLLICLE – produces estrogen sac = produce amniotic fluid (800 ml to 1200ml) CORPUS LUTEUM – produces estrogen and progesterone CHORION – placenta HYPOTHALAMUS – ultimate initiator of menstruation COPACITATION (fetal side of placenta) GONADOTROPIN – collective name of estrogen and − structural changes progesterone to release: − hyaluronidase – to corona radiata IMPLANTATION/NIDATION FUNCTIOS OF ESTROGEN − acrosin – to zona rellucida i. Inhibits follicle stimulating hormone ii. Secondary sexual characteristics – growth of pubic PROTEOLYTIC ENZYME hair; menarche, growth of boobs FERTILIZATION − dissolve in iii. Spinnbarkeit – thin watery fluid secreted by endometrium Bartholin’s gland and Skene’s gland ° Secretions: fertile – thin, watery transparent; ZYGOTE ° Not fertile – viscous white/yellow − 46 chromosome BLASTOCYST − product of fertilization − will remain floating for iv. Menarche 3-4 days v. Ductile structure of breast after one day vi. Inhibits milk production BLASTOMERE vii. Growth of cancer cells − process of mitosis (16 MORULA blastomere) − CARE OF MOTHER, CHILD, AND ADOLESCENT NCM 107 - MATERNAL | BSN2H | FIRST SEMESTER | CHICA NOTE: (1) Zygote and Blastomere = fallopian tube; (2) In the third trimester – transfer of maternal immunoglobin Blastocyst and Proteolytic enzyme = uterus provides the fetus with passive immunity to certain diseases for the first few months after birth. UMBILICAL CORD – contains 2 arteries and 1 vein By week 10 to 12 – genetic testing can be done via chronic ȫ Arteries – carry deoxygenated blood and waste villus sampling (CVS). products from fetus ȫ Vein – carries oxygenated blood and provides PRENATAL NURSING oxygen and nutrients to fetus. During pregnancy Starts from fertilization FETAL HEART RATE i. FHR depends on gestational age; FHR is 160 to 170 DEFINITION OF TERMS bpm in the first trimester but slows down with fetal GRAVIDA – pregnant woman; number of pregnancy. growth to 110 to 160 bpm. ȫ Nulligravida – never been pregnant ii. FHR is about twice the maternal heart rate. ȫ Primigravida – pregnant for the first time ȫ Multigravida – pregnant two or more times FETAL CIRCULATION BYPASS ȫ Grandmultigravida – pregnant five or more times Fetal circulation bypass is present due to nonfunctioning lungs. PARA – pregnancy that reach the age of viability (AOV) and Bypass must close after birth to allow blood to flow delivered (regardless of outcome). through the lungs and the liver. ȫ Nullipara – never delivered viable fetus Ductus arteriosus connects pulmonary artery to aorta – ȫ Primipara – one pregnancy to viability bypassing lungs. ȫ Multipara – two or more pregnancy to viability Ductus venosus connects umbilical vein and inferior ȫ Grandmultipara – five or more pregnancy to viability vena cava – bypassing liver. Foramen ovale is the opening between the right and left AOV PARAMETER: atria of the heart – bypassing the lungs. − 20 weeks age of gestation; or − ≥ 500 grams (fetus) weight; or − crown-to-heel length (baby’s height) ≥ 25 cm OBSTETRIC HISTORY – “OB score”; GP TPAL ȫ G – gravida ȫ P – para (how many) ȫ T – term (how many fetuses reached the full term AOG; 37 to 42 weeks) ȫ P – preterm (20 to 36 AOG) ȫ A – abortion (failed to reach AOG) ȫ L – living child PARANUTRIENT – woman in labor PUERPARA – post-partum mother EARLY NEONATAL DEATH – death of newborn within 7 days postpartum LATE NEONATAL DEATH – death of newborn between 7 to 29 days postpartum BIRTH WEIGHT NEWBORN WEIGHT (NBW) – ≥ 2500g to 3999g EXTREMELY LOW BIRTH WEIGHT (ELBW) – < 1000g VERY LOW BIRTH WEIGHT (VLBW) – < 1500g LOW BIRTH WEIGHT – < 2500g LARGE FOR GESTATIONAL AGE (LGA) – “macrosomia” = super big; ≥ 4000g AMNIOTIC FLUID WOMAN OF REPRODUCTIVE AGE (WRA) – 15 to 49 years Consist of 800 to 1200 mL by end of pregnancy. old; “fertility age” Surrounds, cushion, and protects the fetus and allows for fetal movement. GESTATION – fertilization until delivery; prenatal period Maintains body temperature of the fetus. − 280 days (9 months calendar; 10 months Contains fetal urine and is a measure of fetal kidney linear months) function. NOTE: Calendar month = 30-31-29; Linear month = 28 days Fetus modifies the amniotic fluid through the processes period of swallowing, urinating, and movement of fluid through the respiratory tract. AGE OF GESTATION (HOW TO COMPUTE) PLACENTA NAEGELE’S RULE Provides for exchange of nutrients and waste products Used to estimate EDC (estimated date of confinement) between fetus and mother. and EDD (estimated date of delivery) Begins to form at implantation; structure is complete by FORMULA: week 12. LMP + 9 months + 7 days Produces hormones to maintain pregnancy and assumes − LMP = first day of last menstrual period full responsibility for the production of these hormones by 12th week of gestation. CARE OF MOTHER, CHILD, AND ADOLESCENT NCM 107 - MATERNAL | BSN2H | FIRST SEMESTER | CHICA QUICKENING RULE (Q-RULE) ȫ 16 – fundus is midway umbilicus and symphysis P – 18 to 20 weeks AOG pubis − date of quickening + 154 days = EDC ȫ 28 – fundus is midway umbilicus and xiphoid process M – 16 to 18 weeks of AOG ȫ 40 – descend 4cm = lightening/engagement − date of quickening + 168 days = EDC/EDD FH (cm) ≅ fetal age in weeks (± 2cm) EXAMPLE: If FH is 28 cm = AOG 28 weeks (26-30 weeks) SIGNS OF PREGNANCY 1. PRESUMPTIVE – subjective; only the mother knows LEOPOLD’S MANUEVER 2. PROBABLE – objective; measurable Systematic process of palpation and observation 3. POSITIVE – undeniable sign To determine: fetal presentation; fetal lie; fetal attitude; fetal position PRESUMPTIVE 6 months AOG (24 weeks AOG) B – breast changes U – urinary frequency MANUEVER NAME PURPOSE F – fatigue 1 Fundal grip Determine fetal A – amenorrhea presentation M – morning sickness 2 Umbilical grip Determine fetal C – chloasma (mask of pregnancy) = pigment of face back (location) – L – linea negra smooth hard I – increased skin pigmentation resistant surface S – striae gravidarum 3 Pawlick’s grip Determine Q – quickening degree of engagement PROBABLE 4 Pelvic grip Determine fetal H – Hegar’s sign attitude or degree C – Chadwick’s sign = discoloration of: (1) cervix (violet); (2) of flexion vagina; (3) vulva; 6 weeks AOG G – Goodell’s sign = softening of cervix (8 weeks AOG) Before performing LM: P – positive pregnancy test (1) Empty bladder – cardinal rule A – abdominal/uterine enlargement (2) Position – dorsal recumbent B – Braxton Hick’s Contraction = irregular, painless, (3) Hand temperature – warm intermittent (false labor) E – elevated basal body temperature Risk in position: Supine Hypotension Syndrome (SHS) B – ballottement = rebounding of fetus against examiner’s Abdominal aorta will get compressed finger Blood from the heart won’t reach the feet (vice versa) POSITIVE BP = Cardiac output x Systemic Vascular Resistance FETAL NOTE: ȫ heart tone i. Cardiac output – heart rate x stroke volume ȫ movement − Heart rate = freq. of heartbeat; Stroke ȫ outline volume = preload, afterload, contractability ȫ skeleton Preload – blood from the veins entering the heart UTS FINDING Afterload – blood from the arteries entering the heart ȫ ultrasonographic findings Contractability – depends on the contraction of heart DOPPLER – 10 to 12 weeks ii. Systemic Vascular Resistance – blood vessels FETOSCOPE may be: vasodilation (diameter of blood vessel is big; no much resistance bcs blood vessel is big), FUNDIC HEIGHT/FUNDAL HEIGHT vasoconstriction (diameter of blood vessel is small; Used to evaluate the AOG or gestational age resistance happens when blood vessels are NOTE: Measurement starts at symphysis pubis constricted) After performing LM: Position in left-lateral position. INVOLUTION Return of uterus to its pre-pregnant size. NOTE: After 1-hour post-partum, fundus is at the level of umbilicus. 1cm/day – rate of involution 7 days post-partum = symphysis pubis level 10 days post-partum = non palpable 6 weeks post-partum = return to pre-pregnant size When listening to fetal heart tone: Cephalic – lower quadrant Breech – upper quadrant AGE OF GESTATION: ȫ 36 weeks – fundus is at xiphoid process ȫ 20-22 weeks – fundus is at umbilicus CARE OF MOTHER, CHILD, AND ADOLESCENT NCM 107 - MATERNAL | BSN2H | FIRST SEMESTER | CHICA PHYSIOLOGICAL MATERNAL CHANGES ȫ nipples = pronounced Physiological adaptation to pregnancy ȫ areola = darker ȫ colostrum = rich in antibodies; as early as 4 mos. CARDIOVASCULAR SYSTEM antepartum; normally 2nd to 3rd postpartum (yellowish); 1. BP – ↑ by 40 to 50% (+2L: 1.5L plasma; 0.5L RBC) 2. Supine hypertension syndrome INTEGUMENTARY SYSTEM 3. Physiological anemia – ↑ plasma (hemodilution); 1. ↑ MSH – ↑ melanin → ↑ pigmentation normal when pregnant ȫ Linea Negra 4. Iron requirement – ↑ FE ȫ Chloasma – forehead, cheek, nose 5. Sodium and water retention – ↑ in blood volume ȫ Striae gravidarum – purple stretchmarks NOTE: (1) Hypertension – sitting position; (2) Normal bp – 2. Vascular Spider Nevi – neck, chest, face, arm, legs left-lateral position; (3) Hypotension – supine hypotension ȫ ↑ estrogen syndrome (SHS) 3. ↑ growth rate of hair GASTROINTESTINAL SYSTEM MUSCULOSKELETAL SYSTEM 1. Nausea and vomiting (emesis gravidarum) = HCG (human chrionic gonadotropin) – hormone produced by 1. ↑ production of relaxin + ↑ progesterone plasma ȫ Waddling gait ȫ Lordosis – pride of pregnancy Normal during first trimester: ↑ estrogen; ↓ maternal glucose. ȫ ↑ pelvic dimension ȫ Abnormal if nausea is still present at 2nd and 3rd trimester. PRIORITY: (1) Safety in mobility; (2) Correct posture NOTE: i. First trimester – 1st 12 weeks + 6 days PSYCHOLOGICAL ADAPTATION ii. Second trimester – 13 to 27 weeks + 6 days 1ST TRIMESTER – “I am pregnant.” iii. Third trimester – 28 weeks until delivery 2nd TRIMESTER – “I am going to have a baby.” 3rd TRIMESTER – “I am going to be a mother.” 2. Constipation – ↑ progesterone → relaxes muscle; pressure of uterus → intestine (GIT motility) AMBIVALENCE – mixed contradictory feeling. Flatulence/Heartburn – ↑ progesterone: (1) ↓ GIT motility; ACCEPTANCE – depends on readiness; identifying with (2) ↓ relaxation of cardiac sphincter. maternal role. 3. Hemorrhoids – ↑ venous pressure FIVE TASKS: 1. Accept the pregnancy. 4. Epulis – swelling of the gums; ↑ estrogen; soft bristled 2. Identifying with mothering role. toothbrush 3. Solidify relationship with partner. 5. Ptyalism – ↑ saliva; ↑ estrogen 4. Establish relationship with newborn. 5. Prepare for childbirth. RENAL SYSTEM 1. ↑ frequency in urination – 1st trimester (enlarging) and EMOTIONAL LIABILITY – mood swings BODY IMAGE CHANGES 3rd trimester (lightening) RELATIONSHIP WITH THE FETUS ȫ ↑ pressure sa uterus ȫ↑ GFR (glomerular filtration rate) ȫ↑ blood flow in kidney DISCOMFORT OF PREGNANCY 2. Decreased bladder tone – ↑ progesterone I. NAUSEA AND VOMITING 3. Lactosuria – milk in urine 1st trimester – normal → presence of human chorionic gonadotropin (produced 4. Nocturia – ↑ in frequency of urinary at night by plasma ang HCG) → other hormones such as estrogen, progesterone ENDOCRINE SYSTEM → fetus (organogenesis) – needs more glucose. 1. Basal metabolic rate – ↑ = ↑ secretion of thyroid 2nd to 3rd trimester – abnormal if NV is still present. hormones → Hyperemesis gravidarum (Abnormal OB) 2. Prolactin – pituitary gland responsible for lactation N! 3. Oxytocin – contraction of uterus a. Eat dry crackers before arising. b. Avoid brushing teeth immediately after arising. 4. ↑ Melanocyte Stimulating Hormone (MHS) – c. Eat small, frequent, low-fat meals during the day. pigmentation d. Drinking liquid – between meals 5. ↑ Aldosterone – responsible for Na and H2O retention e. Avoid fried food and spicy foods. f. Acupressure – alternative health care REPRODUCTIVE SYSTEM g. Antiemetics – as prescribed by doctor. 1. Uterus – pear = ovoid; 60g → 1000g 2. Cervix II. SYNCOPE ȫ Chadwick’s → fainting or passing out; temporary loss of ȫ Goodell’s consciousness. ȫ Effacement (softening) and dilatation (widening) → normal = during 1st trimester 3. Ovaries – secrete progesterone (6 to 7 weeks AOG) → cause: hormonal or hemodilution 4. Vagina – ↑ secretion; acidic → 2nd and 3rd trimester – abnormal = SHS → N! LLP 5. Breast ȫ ↑ size CARE OF MOTHER, CHILD, AND ADOLESCENT NCM 107 - MATERNAL | BSN2H | FIRST SEMESTER | CHICA N! → cause: venous congestion = compress; blood don’t a. Sitting with feet elevated flow much papuntang extremities b. *Risk for falls N! c. Change position slowly to LLP a. Support stockings/support hose b. Elevate/elevation of feet & hips III. URINARY FREQUENCY/URGENCY c. Avoid long period standing → usually 1st trimester (enlarging) and 3rd trimester d. Moving about while standing (lightening) e. Avoid leg crossing → pressure by the uterus to the urinary bladder f. Avoid constricting pants N! g. Leg exercise a. Fluid intake = (at least) ≥ 2000mL per day h. Avoid airlines/planes → more on daytime b. Evening – limit fluid intake X. HEADACHE → avoid drinking 2 hrs before sleep. → normal: 1st trimester c. Voiding at regular intervals → hormonal; hemodilution d. Sleeping = side lying position N! e. Perineal pads a. Change position slowly f. Kegel’s exercise – strengthen perineal muscle. b. Cool compress to the forehead c. Small snacks IV. BREAST TENDERNESS d. Acetaminophen, as prescribed → pain upon tactile stimulation → pain is felt all throughout the pregnancy XI. HEMORRHOIDS → cause: E & P → normal: 2nd to 3rd trimester → in prep for parenting → ↑ venous pressure N! → constipation a. Wear supporting bra N! b. Avoid soap – on nipple/areola a. Warm sitz bath → causes dryness b. Use soft pillows V. INCREASE VAGINAL DISCHARGE c. ↑ fluid, ↑ fiber → hormonal d. ↑ exercise = ↓ GIT motility → hypertrophy of vaginal mucosa e. Ointments, suppositories, compresses – as N! prescribed a. Cleansing and hygiene technique b. Cotton underwear – absorbs moisture XII. CONSTIPATION → fungal infection if always wet → normal: 2nd to 3rd trimester c. Avoid douching – affects normal flora → ↓ GIT motility = progesterone → displacement of intestines VI. NASAL STUFINESS → pressure of uterus → normal: 1st – 3rd trimester → iron supplements → cause: ↑ estrogen = edema of nasal tissue; N! dryness a. ↑ fluid (at least 2L), ↑ fiber N! a. Humidifier b. ↑ exercise, walking = at least 20 mins per day) b. Nasal spray/Antihistamine, as prescribed c. Softener, laxative, enema – as prescribed VII. FATIGUE XIII. BACKACHE → 1st and 3rd trimester → normal: 2nd to 3rd trimester N! → main cause: exaggerated lumbosacral curve → a. Arrange frequent rest period relaxin; ↑uterine size b. Correct posture and body mechanics WOF: RISK FOR FALL! c. Regular exercises N! d. Muscle relaxation and strengthening exercise a. Rest (specifically hips and legs) b. Correct posture/body mechanics e. Avoid stimulants (coffee, tea, softdrinks) c. Shoes: low-heeled d. Pelvic rocking exercise VIII. HEARTBURN e. Firm mattress (bed) → hormones → ↑ progesterone – relaxation of muscles XIV. LEG GRAMPS → displacement of stomach → same with varicose veins N! → venous pressure a. Small frequent feeding → altered calcium phosphorus balance → hormonal b. After meal: sit for at least 30 mins. changes c. Avoid fat and spicy food N! d. Milk = small amount; non-fat milk a. Leg exercise – dorsiflexion e. Tailor-sitting exercise – strengthen abdominal b. ↑ calcium intake muscle tone Calcium carbonate f. Antacids, as prescribed ⎯ given to pregnant woman ⎯ 20th AOG (start) until delivery IX. VARICOSE VEINS / ANKLE EDEMA ⎯ 1.25g with 500mg calcium carbonate → normal: 2nd and 3rd trimester ⎯ 40mcg of elemental calcium ⎯ 1 tab tid CARE OF MOTHER, CHILD, AND ADOLESCENT NCM 107 - MATERNAL | BSN2H | FIRST SEMESTER | CHICA XV. SHORTNESS OF BREATH 5.4 – Chlamydia infection → normal: 2nd to 3rd trimester ⎯ mode of transmission: vaginal birth → displacement of diaphragm → neonatal conjunctivitis → ↑ O2 requirement → pneumonia N! → premature rupture of membrane (PROM) – a. Rest premature labor, premature delivery, premature baby b. Sleep position: fowler’s position / LLP → postpartal endometritis MATERNAL RISK FACTORS 5.5 – Trichomoniasis ⎯ PROM 1. AGE ⎯ Postpartal endometritis → younger than 20 years old → older than 35 years old 5.6 – Genital herpes simplex virus ⎯ Vaginal birth → cesarian is required 2. ADOLESCENT PREGNANCY Reason/Factors: 5.7 – HIV ⎯ Early onset of menarche ⎯ mode of transmission: blood & other bodily fluids ⎯ Sexual behavior → semen ⎯ Family problem → urine ⎯ Poverty → vaginal secretions ⎯ Lack of knowledge ⎯ Zidovudine = administered to mother in pregnancy Concerns: ⎯ Poor nutritional status 6. SUBSTANCE ABUSE ⎯ Emotional difficulties → preterm ⎯ Lack of support systems → LBW ⎯ ↑ risk of stillbirth → fetal bradycardia ⎯ LBW infant → abruptio placenta ⎯ Fetal mortality → crosses placenta – teratogenic; may cause physical ⎯ CPD (cephalopelvic disproportion) deformities Smoking: ⎯ ↑ maternal complications → LBW → ↑ HPN (hypertension) → birth defects → anemia → stillbirth → prolonged labor Alcohol: → infection → fetal alcohol syndrome N! – Regular Prenatal Checkup → physical abnormalities → birth defects 3. NUTRITION → congenital anomalies Risk factors: ⎯ Folic acid is needed to prevent NTD (neural tube defect) and OF (orofacial clefts) Prenatal: folic acid supplementation with iron → ASAP during pregnancy → 180 tablets (OD for 6 months) → 60mg = Fe → 400mcg = Folic acid 4. GERMAN MEASLES (RUBELLA) → first 8 weeks AOG → teratogenic – fetal malformation 5. STI (SEXUALLY TRANSMITTED INFECTION) 5.1 – Syphilis ⎯ crosses placenta ⎯ abortion ⎯ mental subnormality ⎯ physical deformities 5.2 – Human papillomavirus ⎯ condyloma acuminatum ⎯ mode of transmission: vaginal birth ⎯ tumors → larynx 5.3 – Gonorrhea ⎯ does not cross placenta ⎯ mode of transmission: vaginal birth → ophthalmia neonatorum → pneumonia → sepsis