Maternal and Child Midterm PDF

Materna and Child: Maternal and Child Discussion (Midterms) Fetal Circulation The fetal circulation system is distinctly different from the adult circulation. This intricate system allows the fetus to receive oxygenated blood and nutrients from the placenta. It is comprised o...

Materna and Child: Maternal and Child Discussion (Midterms) Fetal Circulation The fetal circulation system is distinctly different from the adult circulation. This intricate system allows the fetus to receive oxygenated blood and nutrients from the placenta. It is comprised of the blood vessels in the placenta and the umbilical cord, which contains two umbilical arteries and one umbilical vein (AVA) Baby Normal Adult Veins - Oxygenated Blood Veins - Non-oxygenated Blood Arteries - Non-oxygenated Blood Arteries - Oxygenated Blood This happens because the baby's lungs inside the womb cannot fully function yet. Due to this, the placenta is the one that acts as the role of the lungs for the baby. Three Shunts in the Fetal Circulation 1. Ductus Arteriosus - Protects the lungs against circulatory overload - Allows the right ventricle to strengthen high pulmonary vascular resistance - Low pulmonary blood flow and carries most med oxygen-saturated blood 2. Ductus Venosus - Fetal blood vessels connecting the umbilical vein to the IVC - Blood flow regulated via the sphincter - Carries mostly high oxygenated blood 3. Foramen Ovale - Shunts highly oxygenated blood from the right atrium to the left atrium These 3 shunts are open while the baby is inside the womb however once the baby comes out, all these 3 will close so there would no abnormalities Chambers of the Heart 1. Inferior Vena Cava  2. Right Atrium (have 2 routes; RV or LA) 3. Right Ventricle 4. The lungs (supplies nutrients) 5. Left Atrium 6. Left Ventricle 7. Then, Aorta 1. Placenta - Umbilical Vein 2. Enters Umbilical cord 3. Enters/Bypass Ductus Venosus - gives a supply of oxygen and nourishment to Liver 4. Liver 5. Inferior Vena Cava 6. Right Atrium - two routes; RV or LA (1st Route) 7. Right Ventricle - valve: Mitral Valve 8. Enters lungs - Pulmonary vein that carries oxygenated blood to give nutrients to lungs 9. Pulmonary Artery 10. Left Atrium 11. Left Ventricle - Ductus Artiosus connecting to Aorta for systemic circulation 12. Aorta (2nd Route) 13. Right Atrium - enters foramen ovale 14. Left Atrium 15. Left Ventricle - valve: Triscupid valve 16. Aorta - for systemic Circulation  17. Goes to Upper and Lower Extremities to supply blood 18. Goes back to the Umbilical Artery - carries non-oxygenated blood 19. Placenta Signs of Pregnancy There are 3 categories; Presumptive, probable, and Positive Presumptive Signs These are signs thats have only been felt by the mother M - Morning Sickness; Nausea and Vomiting due to an increase of hCG A - Amenorrhea; absence of menses due to high progesterone production by corpus luteum C - Changes on the skin; Melasma (Mask of Pregnancy), Lingia Nigra, Stretch Marks F - Fatigue due to a double of blood supplies and an increase of 50% of blood volume (increase of 10 bpm heart rate) L - Lastitude (tiredness) U - Urinary Frequency because of the pressure in the bladder Q - Quickening (first fetal movement); Primi: 18-20 weeks, Multi:: 16-28 weeks AOG Probable Signs These are signs that have been felt by the examiner; Objectives C - Chadwick Sign; blueish discoloration of the vagina due to the cut of blood supply H - Hegar’s; softening of the lower uterine segment (like butter) U - Uterine Enlargement; starts on the 12th week, above the symphysis pubis  P - Positive Pregnancy Test (HCG) B - Ballotment; 16-20 weeks AOG, you can feel when you tap the cervix portion, the baby will bounce back O - Outline of Fetus G - Goodells Sign; softening of cervix due to estrogen and hormones B - Braxton Hicks; painless contraction Positive Signs These are signs for confirmatory F - Fetal Heart Tone; 120-160 bpm, anything above or below is called Fetal Distress. 10 weeks (Doppler), 16 weeks (Fetalscope), 18-20 weeks AOG (Stethoscope) M - Movement felt by the examiner using Leopold’s Maneuvers S - Skeletal System; X-ray (During 2nd Trimester above), UTZ (Ultrasound) Physiological Adaptions of Pregnancy Uterus (Enlargement) Locations: 1. Symphysis Pubis (12 weeks) - 16 weeks - between SP and Umbilicus 2. Umbilicus (20 weeks) - 24 weeks - 2 finger above the umbilicus - 30 weeks - midway between Umbilicus and XP 3. Xiphoid Process (36 weeks) - 40 weeks - XP and Umbilicus because of Lightening (fetal head descending/settling in the pelvis) positioning of baby before birth Cervix - Before pregnancy Pinking; During pregnancy Purplish - Leukorrhea means an increase in the production of mucus and WBC. Protection of Fetus against bacteria and infection (high estrogen) - Result of Operculum Plug, seals bacteria and infections - Goodells Sign - Hegar’s Sign (starts at 6 weeks) - Chadwick Sign - Increase of acidic pH >6 for protection Gastrointestinal System - Morning Sickness due to high HCG. Intervention: eat crackers or suck on ice chips - Hyperemesis gravidarum - persistent vomiting (lasts only up until the end of the 1st Trimester) - Constipation - high progesterone results in slow peristaltic movement. Intervention: Increase oral intake and eat high-fiber foods  - Heart Burn (Pyrosis) - a decrease of gastric motility which causes slow gastric emptying which causes high pressure in the uterus. intervention: aluminum hydroxide (amphojel) / magnesium hydroxide & small frequent feeding and avoid fatty spicy food Integumentary System - Striae gravidarum - stretching of the abdominal wall causing rupture of connective layer of the skin causing pink to reddish streaks (pregnant) after pregnancy will turn into silver streaks - Chloasma/Melasma - brown pigmentation in nose, chin, and cheeks (hyperpigmentation) - Linua Nigra - brown pinking line at the SP and below Umbilicus Endocrine System - Slight Enlargement of Thyroid gland Skeletal System - Lordosis - Pride of Pregnancy - Waddling Gait - walk like penguin - Leg cramps - prolonged standing, over fatigue, increase in calcium and phosphorus Prenatal Care Also known as pre-pregnancy or antenatal care. Essential for ensuring the overall health of newborns and their mothers and a major strategy for helping mothers reduce complications of pregnancy Medical care that you do during pregnancy Develop a plan for their reproductive life Healthy care you get while you are pregnant Components of Prenatal Care 1. History taking - LMP, 2. Physical examination 3. Treatment of disease 4. TT immunization 5. Iron Supplementation 6. Health education - Health Teaching 7. Laboratory examination - Urine and Fecal Analysis, CBC, UTZ 8. Oral-dental examination 9. Referral when necessary Obstetric History 1. History of Past Pregnancy - G - number of pregnancies irrespective of gestational age (Gravida) NUMBER OF PREGNANCY  - P - number of pregnancies that has reached viability NUMBER OF DELIVERY - T - number of full term infants (38-42 weeks AOG) - P - number of preterm infants (20-37 weeks AOG) - A - number of spontaneous or induced abortions (20 weeks AOG and weigh =t of >500 grams) Assessment of Fetal Growth Fetal Heart tone: 120-160 bpm Movement: Quickening (28-38 weeks AOG) 10 movements per day Naegele’s Rule - Determine the expected date of Delivery (EDD/EDC) - -3, +7, +1 (Computation after getting LMP) - Applicable for April - December (-3, +7, +1) - January-March (+9, +7) Mcdonald’s Rule - Determine to estimate the AOG, EDC via Fundic Height (Calculate AOG) - Fundic Height (cm) x 2/7 = AOG Lunar month - Fundic Height (cm) x 8/7 = AOG in weeks Bartholomew’s Rule - Calculate the AOG based on the location of Fundus Landmarks 1. Symphysis Pubis 2. Umbilicus 3. Xiphoid Process 12 weeks - level of SP 16 weeks - between SP and U 20 weeks - level of U 24 weeks - 2 fingers above U 30 weeks - between U and XP 34 weeks - below XP 36 weeks - level of XP 40 weeks - below XP - Lightning Johnson’s Rule - Calculate and Determine the Fetal weight in grams - FH (cm) - N x K = Fetal Weight FH - fetal height in cm N - 12 if engaged & 11 if NOT engaged K - 155 (constant) Leopold’s Maneuver - Determine the condition of the baby inside the uterus (36 weeks AOG) Prior 1. Instruct mother to empty bladder 2. Warm hands (cold can cause constriction to lead to contraction) 3. Warm the Stethoscope (Bell) Fundal Grip - Determine the fetal presentation (Cephalic or Breech) - Location: at fundus Umbilical Grip - Locate the Fetal back or Fetal heart tone Pawlicks Grip - Determine the engagement of the presenting part (one hand only) - Movable: Not engage - Not movable: engage Pelvic Grip - Determine the degree of flexion - Facing the foot of the mother Additional Notes: https://www.slideshare.net/slideshow/prenatal-care-74309748/74309748