Midterms Maternal And Child Nursing PDF

Maternal and Child Nursing Trophoblast  placenta X amniotic membrane Stages of Fetal Development  cells in the outer ring Fetal Development...

Maternal and Child Nursing Trophoblast  placenta X amniotic membrane Stages of Fetal Development  cells in the outer ring Fetal Development  part of the structure that will later form the  orderly and intricate process. It begins before a placenta and membranes woman knows that she is pregnant and ends with the birth of the baby. Embryoblast  Between conception and delivery, there are  inner cell mass many detailed steps that must occur  portion of the structure that will form the embryo Endometrium  vascularized = rupture of capillaries due to implantation Implantation  contact between the growing structure and the uterine endometrium, occurs approximately 8 to 10 days after fertilization.  Usually occurs high in the uterus on the posterior surface.  Placenta Previa = point of implantation is low in the uterus; the growing placenta may occlude the cervix which makes the birth of the child Factors Affecting Fertilization difficult due to the blockage of placenta in the  Equal maturation of both sperm and ovum birth canal  Ability of the sperm to reach the ovum  Once implanted, the zygote is called an embryo  Ability of the sperm to penetrate the zona  Important step in pregnancy because 50% of pellucida and cell membrane and achieve zygote never achieve it fertilization.  Small amount of vaginal spotting appears on the day of implantation because capillaries are Cleavage / Mitosis ruptured by the implanting trophoblast cells LMP (for irreg)  could mistake implantation bleeding for menstrual period  predicted date of the baby will be 4 weeks late  28 days fixed cycle  Occur for a rate of 1 every 22 hours Period of Fetal Development  By the time it reaches the zygote, it consists of 16 – 50 cells Blastocyst  after 3 to 4 days, large cells tend to collect at the periphery of the ball, leaving fluid space surrounding an inner mass Terminologies in Fetal Growth Placenta  Latin word for “pancake”  Ovum – ovulation to fertilization  Discoid: 15 to 20 cm in diameter & 2 to 3 cm in  Zygote – fertilization to implantation thickness.  Embryo – implantation to 3-8 weeks  Location: In the uterus, anteriorly or  Fetus – 9 weeks to term posteriorly near the fundus.  Conceptus – developing embryo and placental  Fetal Side: covered with amnion; beneath it, structures throughout pregnancy the fetal vessels course with the arteries  Age of Viability - Earliest age at which fetuses passing over the veins. survive if they are born (20 to 24 weeks AOG or  Amnion: 0.02 to 0.5 mm in thickness; a sac that if fetus weighs 500 to 600 grams) engulfs the growing fetus  Covering about half the surface area of the Embryonic and Fetal Structures internal uterus at tem Decidua  Latin word for “falling off”  corpus luteum in the ovary continues to function rather than atrophying under the influence of hCG secreted by trophoblast cells.  hCG also causes the uterine endometrium to continue to grow in thickness and vascularity  essential roles in protecting the embryo from being attacked by maternal immune cells and provides nutritional support for the developing embryo prior to placenta formation.  Amniotic Fluid: Clear fluid that collects within Chorionic Villi the amniotic cavity.  Produce various hormones such as hCG,  Maternal Side: Divided into irregular lobes; somatomammotropin/human placental consists of fibrous tissue with sparse vessels lactogen (hPL), estrogen and progesterone. confined mainly to the base.  Cytotrophoblast (Langhans Layer)  middle layer, protect the embryo and fetus  Average weight at term is 500 grams Feto- from infectious organisms such as placental weight ratio at term is 6:1 spirochete of syphilis early in pregnancy  Placental Maturity: 12 weeks or 3 months; (before 20 weeks). functions most effectively through 40 to 41  Disappears between 20th and 24th week, weeks; may be dysfunctional beyond 42 weeks. syphilis is not considered to have high potential for fetal damage in early Functions of Placenta pregnancy, ony after cytothropoblast are no  Transport nutrients and water - soluble vitamins longer present to the fetus  Offer litter protection against viral infection  Serves as fetal organ for respiration and medium of excretion through amniotic fluid  Have central core consisting of connective  Serves as a protective barrier to some tissue and fecal capillaries surrounded by a substances and organisms such as heparin and double layer bacteria. Secrete the following hormones: Estrogen Progesterone hCG hPL or hCS Umbilical Cord Amniotic Fluid  Length: On average 55 cm with range of 30 to  clear, straw-colored fluid in which the fetus 100 cm. (52 cm in length sa book) floats.  Diameter: 0.8 to 2.0 cm at term  Origin: Initially from maternal serum or plasma  cord extends from the fetal surface of the but by the second half of pregnancy (10th placenta to the fetal umbilicus. week), fetal urination and swallowing  Blood flow at term – 350mL per minute contribute significantly to the volume of the  Counting number of coils in cord = use to amniotic fluid. predict healthy fetal growth  Amount:500 – 100mL/ 800 to 1,200 mL at term  Hypercoiling = associated with maternal  pH Level: Neutral to Alkaline (7 to 7.25) hypertension and respiratory distress in  Hydramnios newborn  excessive amount of fluid due to unable to  Have no nerve supply swallow of the fetus (esophageal atresia / anencephaly) Parts  may occur in people with diabetes due to  Composed of 3 umbilical vessels; 1 vein (carry hyperglycemia which causes excessive fluid blood from placenta to fetus) and 2 arteries shifts into the amniotic space (carry blood from fetus to placenta)  Oligohydramnios – problem sa kidney  Polyhydramnios – difficulty in swallowing;  Wharton’s jelly di masyado nadevelop ang NS  specialized connective tissue, an extension of the amnion, which Functions of Amniotic Fluid surrounds the umbilical cord to prevent 1. Serves as a protective cushion/shock absorber. cord compression. 2. Separates the fetus from membranes, allowing  Gelatinous mucopolysaccharide symmetrical growth & free movement 3. Acts as a medium of excretion  Blood volume in the cord also help to prevent 4. Serves as a fetal drink. cord compression. 5. Serves as a specimen for periodic diagnosis exams to determine fetal well-being or its Functions absence  To transport oxygen and nutrients to the fetus 6. Maintain the fetal temperature and to return metabolic wastes from the fetus 7. Equalizes uterine pressure and prevent marked to the placenta. interference with placental circulation during labor. Amniotic Membranes  dual – walled sac with the CHORION as the Origin and Development of Organ Systems outermost part and the AMNION as the innermost part. Stem Cells  Fuse together and appear to be 1 sack at term Totipotent Stem Cells (first 4 days of life)  Also known as BAG OF WATER (BOW)  Undifferentiated cells that have potential to  No nerve supply hence when it ruptured, grow into any cell in the human body neither the pregnant mother nor fetus may  Duplicate with the same function experience pain  support the amniotic fluid and contribute to the Pluripotent Stem Cells - Cells begins to differentiation production of the fluid. to become any body cell. They are slated to become specific body cells  produces a phospholipid that initiates the Multipotent Stem Cells - so specific to become a formation of PROSTAGLANDINS which are particular body organ. necessary during labor and fetal development Zygote Growth Cephalocaudal (Head – to – tail)  Head development occurs first, followed by the 8 Weeks middle and finally the lower body parts.  Head size is large in proportion to the body, neuromuscular development and some Layers of the Blastocyst movements. Endoderm - Inner Layer; develops into:  Rapid brain development  Linings of the GIT from the pharynx to the  External genitalia appear rectum  Liver, pancreas, thyroid and parathyroid 12 Weeks  Respiratory tract  Placenta fully formed and functioning kidneys  Bladder and thymus (for immunity building) develop; secrete urine; centers of ossification in  Develop into lining of pericardium, pleural most bones cavity - peritoneal  With sucking and swallowing  Gender distinguishable Ectoderm – outer layer; develops into:  FHT detected by ultrasound  Nervous System ; wala epidermis  Crown – rump fetal length is 6 to 7 cm – uterus  Hair, nails, skin epidermis, sebaceous and sweat just palpable above the symphysis pubis glands  Salivary glands, and mucous membrane of the 16 Weeks mouth  More human appearance  Epithelium of nasal and oral passages.  Quickening felt by multigravida  Meconium in the bowels Mesoderm - middle layer; develops into:  External genitalia are obvious; gender correctly  Dermis determined by experienced observers by  Cardiovascular system inspection of the external genitalia at 14 weeks.  Reproductive system  Scalp hair develops  Musculo – skeletal system  Formed eyes, nose and ears  Urogenital system, except the bladder  FHT detected by fetoscope  By the end of 16 weeks, crown – rump length is Stages of Embryonic Period 12 cm, fetal weight is 110 g  Gastrulation – formation of blastocyst layers: Ectoderm, Mesoderm & Endoderm 20 Weeks  Neurulation – formation of neural tissue  Skin is less transparent  Organogenesis – development of the organs  With vernix caseosa and downy lanugo covering the entire body. Intrauterine Growth and Development  Strong quickening felt by primigravida 4 Weeks  FHT is audible using stethoscope  All systems in the rudimentary form; beginning  Bone hardening | Weight more than 300 g of eyes, nose and GIT.  Partitioning of the primitive heart begins; heart 24 Weeks chambers are formed; the heart beats (14  Weight about 630 g. days); the heart is completely formed by the  Body well – proportioned end of 6 weeks  Skin is red and wrinkled; fat deposition begins  With arm and led buds  Hearing established  By the end of the 4th week after ovulation, the  Eyebrows and eyelashes are recognizable chorionic sac is 2 to 3 cm in diameter, and the  Canalicular period of lung development embryo is about 4 to 5 mm in length 28 Weeks Fetal Circulation  Weight: 1,100 g; Crown – rump length: about 25 cm.  Viable; immature if born at this time; surfactant production begins.  Thin skin, red, covered with vernix caseosa  Body less wrinkled  With iron storage  Nails appear  The pupillary membrane has just disappeared from the eyes. 32 Weeks  Weight: 1,800 g: Crown – rump  length: 28 cm  Subcutaneous fats begin to deposit; the skin is smooth and pink. Fetal Immunity  More reflexes are present  IMMUNOGLOBULIN (Ig) G: Maternal antibodies  With iron and calcium storage cross the placenta into the fetus as early as the  Good chance of survival if delivered 20th week and certainly by the 24th week of intrauterine life. 36 Weeks  It gives fetus a temporary passive immunity  Weight: 2,500 g: Crown – rump length: 32 cm; against diseases for which the mother has Lecithin/Sphyngomyelin ratio is 2:1 antibodies.  Nails firm  With a definite sleep/wake pattern  More rotund body because of subcutaneous fat Assessment of Fetal Growth and Development deposition; lanugo disappearing Fetal Assessment (tests for fetal G & D are commonly  Excellent chance of survival with proper care. done for a variety of reason, including: 1. Predict the outcome of the pregnancy. 40 Weeks 2. Manage the remaining weeks of the pregnancy.  Weight: approximately 3,400 g; Crown – rump 3. Plan for possible complications at birth length: 36 cm 4. Plan for problems that may occur in the  Full term, fully developed, with good muscle newborn infant. tone and reflexes 5. Decide whether to continue the pregnancy.  Little lanugo 6. Find conditions that may affect future  If male, testes in the scrotum pregnancies.  The age at the time of EDC counts from first day of LMP. Nursing Responsibilities  With other characteristic features of the 1. Obtain informed consent newborn 2. Explain the procedure to the pregnant client and family members. *12 weeks – ulbok na mas mataas sa symphysis pubis 3. Prepare the client physically and emotionally. *18 weeks – multigravida 4. Provide support during the procedure. *19 weeks – primary gravida 5. Assess fetal and maternal responses during and after the procedure Xyphoid process and fundus magkalevel = nasa 36 6. Provide any necessary follow up care. weeks na sya 7. Managing the equipment and specimens. Nursing Health History Kick Counts 1. Ask client about any illnesses prior to  Fetal movement that can be felt by the pregnancy. pregnant person occurs at 18 to 20 weeks and it 2. Ask about any medications she takes. intensifies at 28 to 38 weeks. 3. Ask about nutritional intake and personal habits. Rhythm Strip Testing 4. Ask about her environmental exposure  assessment of fetal well – being and assesses (teratogens). the FHR for normal baseline rate. 5. Ask about her previous pregnancy.  Help client into semi – fowler’s position. 6. Ask client about any exposure to communicable  Attach an external fetal monitor diseases such as COVID – 19.  Record the FHR for 20 minutes 7. Ask client about unintentional injuries or  Variability is rated as: intimate partner violence.  Absent – No peak-to-trough range is detectable Physical Examination  Minimal – An amplitude range is  second step in evaluating fetal health. detectable, but the rate is 5 bpm or  Assessing maternal weight and general fewer. appearance can give clues about the nutritional  Moderate or Normal – An amplitude and physical condition of the fetus. range is detectable; rate is 6 to 25 bpm.  Marked – An amplitude range is Assessing Fetal Growth and Health detectable; rate is greater than 25 bpm Fundic Height Measurement  Over the symphysis pubis at 12 weeks Non Stress Testing  At the umbilicus at 20 weeks  Measure the response of FHR to fetal  At the xiphoid process at 36 weeks movement.  Help client into a sitting position. Mcdonald Rule  Attach FHR and a uterine contraction monitor  Measuring from the notch of the symphysis  Instruct the client to push the button attached pubis to over the top of the uterine fundus to the monitor whenever she feel the fetus (ideal for 20th to 31st weeks AOG) move.  Usually done for 20 mins  Reactive – if two accelerations of FHR lasting for 15 seconds occur after fetal movement within the time period.  Nonreactive – if no accelerations occur with the fetal movement. Vibroacoustic Stimulation  specially designed acoustic stimulator is applied to the pregnant client’s abdomen to produce a sharp sound which startles and awakes the fetus. Fetal Heart Rate  sound is approximately 80 dB at 80 Hz in  can be heard and counted as early as 10th to frequency. 11th week of pregnancy using Doppler  Utilized together with nonstress test. ultrasound  Apply a single 1-to-2-second sound stimulation to the lower abdomen if no spontaneous acceleration has not occurred within 5 minutes   Repeat the sound stimulation at the end of 10 minutes if still no spontaneous acceleration. Placental Grading - can be graded based on the amount of calcium deposits present in the base. Ultrasonography  0 = between 12 & 24 weeks  Measures the response of sound waves against  1 = 30 to 32 weeks solid objects, is a much-used tool for fetal  2 = 36 weeks health assessment.  3 = 38 weeks  It can be used to:  Diagnose pregnancy as early as 6weeks Amniotic Fluid Volume  Establish a fetus is growing and has no  measured to estimate the fetal health gross anomalies. particularly the circulatory and kidney  Establish the sex if penis is revealed functions.  Establish the presentation and position of  Between 28 to 40 weeks, the total pockets of the fetus. amniotic fluid ranges from 12 to 15 cm  Predict the gestational age by measurement of biparietal diameter of the Nuchal Translucency head or the crown - rump measurement  Measures the amount of fluid behind the fetus  Discover complications of pregnancy neck during first trimester of pregnancy.  Detect any retained placenta or poor  Used to detect chromosomal anomalies such as uterine involution after birth Down Syndrome, Edwards Syndrome etc  Before the procedure: Biophysical Profile (Fetal Apgar Score) -assess the  patient has received a good explanation overall fetal health. It is a combination of 5 parameters of what the procedure will be like.  Fetal breathing  patient has an assurance that the  Fetal movement process does not involve X-rays and  Fetal tone safe for the fetus.  Amniotic fluid volume  patient should have a full bladder at the  Fetal heart reactivity time of the procedure  Assist patient up to an examination o Biophysical profile may be done as often as daily table and drape them modesty with her during high risk pregnancy. The fetal scores as abdomen exposed follows:  Place a towel under the right buttock to o 0 = absent ; 2 = present tip the body slightly.  8-10 = normal  A gel to be applied must be at room  6 = considered suspicious temperature or slightly warmer.  4 = jeopardized The following are the specific features to be studied by Magnetic Resonance Imaging (MRI) sonogram:  used for fetal assessment to identify structural Biparietal Diameter anomalies or soft tissue disorders.  measured to predict fetal maturity  Most helpful in diagnosing complications such  8.5+ or 9.04cm as ectopic pregnancy or trophoblastic disease.  Di priority: expensive, 5x higher than ultrsound Doppler Umbilical Velocimetry  measures the velocity at which RBCs in the Maternal Serum Analysis uterine and fetal vessels travel  Number of trophoblast cells pass into the  Helpful to determine the vascular resistance maternal bloodstream beginning at about the present in patients with gestational diabetes or 7th week. hypertension.   It can reveal information about the pregnant patient as well as the fetus C. Bilirubin determination  Alpha – Fetoprotein = used to check the fetus’  Incompatibility with maternal and fetal risk to birth defects and genetic disorders blood which may cause increase of  PAPP – A (Pregnancy Associated Plasma - bilirubin Protein A)  Breakdown of RBC, may bilirubin  Protein secreted by the placenta. production  Low level in maternal blood are  Mother will have antibody against sa RBC associated with chromosomal ng fetus anomalies which high level may predict  Specimen must be free of blood or false an LGA baby. positive reading may occur  help modulate insulin like growth factor – help fetus for growth and D. Chromosome Analysis development  Few fetal skin cells are always present in amniotic fluid, may be cultured and Quadruple Screening stained for karyotyping for genetic analysis  venipuncture  analyses 4 indicators of fetal health E. Color  most common maternal serum tests  Normal amniotic fluid = color of water; 1. AFP = Alpha - Fetoprotein may be slightly yellow in late pregnancy 2. Unconjugated Estriol (UE) – enzyme that help  Strong yellow = blood incompatibility estimate fetal well - being  Green = suggest meconium staining, a 3. hCG – help growth factor phenomenon associated with fetal distress 4. Inhibin A  protein produced by placenta and corpus F. Fibronectin luteum  Glycoprotein that plays a part in helping a  higher production = down syndrome placenta attached to the uterine decidua  2nd trimester  Present during pregnancy until 20 weeks  Stimulated after fetal membrane is Fetal Sex damaged  helpful to pregnant patient who has an X –  No presence = abnormality carrying genetic disorders  After 20 weeks meron pa = abnormality  Can identify by ultrasound at 4 months  10 weeks AOG, maternal blood G. Inborn error of metabolism  Error enzyme, non-functional enzyme  Pero can identify as early as 10 weeks  In case of emergency  Number of inherited diseases are caused Invasive Fetal Testing by inborn error of metabolism can be  helpful in getting a more accurate result. detected by amniocentesis  99% reliability rate.  Ex of illness: sickle sell disease, cyctic  Confirmatory purpose only fibrosis, muscular dystrophy, Tay – sachs disease, maple syrup urine disease 1. Amniocentesis (extra amniotic fluid) A. AFP 2. Chorionic Villi Sampling B. Acetylcholinesterase  typically offered when there is a higher risk of  Compound that rises to high levels if a genetic disorders, such as due to advanced neural tube anomaly is present maternal age, family history of genetic  Spinal difida; encephaly conditions, or abnormal results from screening tests like first trimester screening.   Transcervical – posterior, likod ng fundus Normal Antepartum Period  Transabdominal – placenta is at anterior part of Length of Pregnancy uterus  DAYS – 267 to 280  Screening test at first trimester  CALENDAR MONTHS – 9  LUNAR MONTHS – 10 3. Percutaneous Umbilical Blood Sampling  WEEKS – 40  process of aspiration of blood from the  TRIMESTER - 3 LENGTH OF PREGNANCY umbilical vein for analysis.  It is best to express gestational age, or length of  performed through amniocentesis technique pregnancy in weeks.  Blood samples will be examined:  At the expected date of confinement (EDC), the  CBC fetus is 40 weeks’ old  Direct Coombs test  Blood gases Trimesters of Pregnancy  Karyotyping First Trimester (Week 1 – 12)  Period of rapid organogenesis, teratogens such  Blood obtained will initially examine if it is fetal as alcohol, drugs, viruses and radiation are blood through Kleihauer – Betke test. highly damaging.  Fetal heart rate and uterine contraction should be monitored before and after the procedure Second Trimester (Week 13 – 26)  Ultrasound  Most comfortable for the mother  Aspirating of blood  with continued growth of the fetus.  Karyotyping – genetic typing; know number of chromosome in fetal blood Third Trimester (Week 27 – 40)  Need icheck FHR, kase mag increase ung BP to  Rapid deposition of fats, iron and calcium know there’s no adverse reaction  the period of most rapid fetal growth.  Preparation for delivery 4. Fetoscopy  fetus is visualized by inspection through a fetoscope Physiologic Adaptation of Pregnancy  This method allows direct visualization of Reproductive System Changes both the amniotic fluid and fetus.  The main reasons the procedure is used are Uterus to:  Increased uterine size  Confirm the intactness of the spinal  From globular to oval uterine shape column.  New fibroelastic tissues are formed.  Obtain biopsy samples of fetal tissue and  Fundal height changes blood.  Increased vascularity to the pelvic region.  Determine meconium staining  To perform elemental surgery  Braxton Hicks Contractions  Irregular and painless  Earliest time to perform = 16th – 17th week  Practice labor  If fetus is active = Meperidine (Demerol) may  Help strengthen myometrium for future give to sedate the fetus and to avoid fetal injury labor  Carries a small risk of premature labor  Something to do with uterine electrical activity Pregnant Patients with Unique Needs and Concerns  Obese patients  Difficulty in mobilization  Patient with hearing and visual disability   Ballottement  Enlargement of the areola, alveoli duct and  Bounce back reaction from head of the alveoli system fetus when you push the cervix  Darkening of the areola and skin around it  May fetal head na  Enlargement and prominence of superficial veins  Secondary amenorrhea  Enlargement of Montgomery’s glands  Uterine electrical activity  Colostrum (4 to 5 months): Thin, watery light yellow, high protein secretion Cervix  Shorter, thicker and more elastic Endocrine System Changes  With edema and hyperplasia of the mucus Placenta lining  A major endocrine organ during pregnancy  Increased mucus production  The chorion of the placenta secretes hCG, which  Increased vascularity causes the cervix to be functions to: soft ✓ Maintain corpus luteum  Short – developing fetus ✓ Aid in diagnosis pregnancy  Thick – progesterone and estrogen ✓ Elevated in case of excessive vomiting  Hyperplasia – bulky  Hypertrophy – lumalaki in length Anterior Pituitary Gland  Mucus Plug – nakababa sa cervix para  No ovulation maiwasan pag invade ng microorganisms  The breast is prepared for lactation with increased prolactin Vagina  Hypertrophy and hyperplasia Posterior Pituitary Gland  Leukorrhea - maintain acidic level in vaginal  Oxytocin is stored and secreted by the PPG environment  Oxytocin – stimulate uterine contraction  Increased vascularity results in bluish discoloration Thyroid Gland  Changes in thyroid activity resulting in elevated Perineum BMR are due to:  Hypertrophy, edema and relaxation ✓ Elevated serum estrogen  Increased vascularization; changes into deeper ✓ Placental effects on thyroid function color. ✓ Increased renal clearance of iodide.  muscle between anus and vagina  Insulin resistance – di maconvert glucose to Ovaries energy  Ovum production, ovulation cease, and the maturation of the new follicles are suspended  Elevated BMR (up to 25%) with return to  The corpus luteum persists and takes over the normal at 6 th week postpartum hormonal production tasks in early pregnancy.  It functions maximally during the first 6 to 7  Signs of increased thyroid activity: weeks of pregnancy. ✓ Increased PR ✓ Elevated CO Breast  Increased size and firmness ✓ Slight rise in temperature  Tingling sensation in the nipples in 4 weeks and ✓ Heat intolerance tenderness Parathyroid Gland  Enhanced calcium & phosphorus metabolism to meet fetal needs for increased calcium.  The leading cause of cramps in pregnancy is a calcium – phosphorus imbalance Pancreas  Increased insulin secretion in response to increased metabolism in pregnancy.  INSULIN secreted by the pancreas is rendered ineffective by insulin antagonists in pregnancy. Adrenal Cortex  Increased cortisol works at multiple sites: ✓ Promote metabolism of macronutrients. ✓ Activates gluconeogenesis to convert stored protein to glucose  Increased aldosterone promotes sodium retention and thereby water reabsorption.  It also enhances the water – retaining effect of progesterone resulting in the cushingoid feature in pregnancy  Enhibits excretion of sodium  Progesterone = pinapalabas reabsorption of sodium