Nursing Role in Caring for Families During Normal Pregnancy & Birth PDF

NURSING ROLE IN CARING FOR FAMILIES DURING NORMAL PREGNANCY & BIRTH  Stages of Fetal Development Embryonic & Fetal Structures Origin & Development of Organ AGENDA Systems Assessment of Fetal Growth and Development Pregnant Patients with Uni...

NURSING ROLE IN CARING FOR FAMILIES DURING NORMAL PREGNANCY & BIRTH  Stages of Fetal Development Embryonic & Fetal Structures Origin & Development of Organ AGENDA Systems Assessment of Fetal Growth and Development Pregnant Patients with Unique Needs or Concerns STAGES OF FETAL DEVELOPMENT FETAL DEVELOPMENT Fetal development is an orderly and intricate process. It begins before a woman knows that she is pregnant and ends with the birth of the baby. Between conception and delivery, there are many detailed steps that must occur. FERTILIZATION: THE BEGINNING OF PREGNANCY FACTORS AFFECTING FERTILIZATION 1. Equal maturation of both sperm and ovum 2. Ability of the sperm to reach the ovum 3. Ability of the sperm to penetrate the zona pellucida and cell membrane and achieve fertilization. CLEAVAGE/MITOSIS IMPLANTATION It is the 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. PERIOD OF FETAL DEVELOPMENT TERMINOLOGIES IN FETAL GROWTH OVUM: from ovulation to fertilization ZYGOTE: from fertilization to implantation EMBRYO: from implantation to 3 – 8 weeks FETUS: from 9 weeks to term TERMINOLOGIES IN FETAL GROWTH CONCEPTUS: Developing embryo and placental structures throughout pregnancy. AGE OF VIABILITY: Earliest age at which fetuses survive if they are born (20 to 24 weeks AOG or if fetus weighs 500 to 600 grams) EMBRYONIC AND FETAL STRUCTURES DECIDUA The 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 – DECIDUA. DECIDUA DECIDUA It has 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. CHORIONIC VILLI Produce various hormones such as hCG, somatomammotropin/human placental lactogen (hPL), estrogen and progesterone. The middle layer, protect the embryo and fetus from infectious organisms such as spirochete of syphilis early in pregnancy (before 20 weeks). CHORIONIC VILLI PLACENTA Discoid: 15 to 20 cm in diameter & 2 to 3 cm in thickness. Location: In the uterus, anteriorly or posteriorly near the fundus. Fetal Side: covered with amnion; beneath it, the fetal vessels course with the arteries passing over the veins. Amnion: 0.02 to 0.5 mm in thickness; a sac that engulfs the growing fetus. PLACENTA PLACENTA PLACENTA Amniotic Fluid: Clear fluid that collects within the amniotic cavity. Maternal Side: Divided into irregular lobes; consists of fibrous tissue with sparse vessels confined mainly to the base. Average weight at term is 500 grams Feto-placental weight ratio at term is 6:1 PLACENTA Placental Maturity: 12 weeks or 3 months; functions most effectively through 40 to 41 weeks; may be dysfunctional beyond 42 weeks. Functions: Transport nutrients and water- soluble vitamins to the fetus Serves as fetal organ for respiration and medium of excretion through amniotic fluid PLACENTA Functions: Serves as a protective barrier to some substances and organisms such as heparin and bacteria. Secrete the following hormones: Estrogen Progesterone hCG hPL or hCS PLACENTA UMBILICAL CORD Length: On average 55 cm with range of 30 to 100 cm. Diameter: 0.8 to 2.0 cm at term Parts: Composed of 3 umbilical vessels; 1 vein and 2 arteries. UMBILICAL CORD Parts: Wharton’s jelly; specialized connective tissue, an extension of the amnion, which surrounds the umbilical cord to prevent cord compression. Blood volume in the cord also help to prevent cord compression. UMBILICAL CORD The cord extends from the fetal surface of the placenta to the fetal umbilicus. Functions: To transport oxygen and nutrients to the fetus and to return metabolic wastes from the fetus to the placenta. UMBILICAL CORD AMNIOTIC MEMBRANES It is a dual – walled sac with the CHORION as the outermost part and the AMNION as the innermost part. Also known as BAG OF WATER (BOW) No nerve supply hence when it ruptured, neither the pregnant mother nor fetus may experience pain. AMNIOTIC MEMBRANES It support the amniotic fluid and contribute to the production of the fluid. It also produces a phospholipid that initiates the formation of PROSTAGLANDINS which are necessary during labor and fetal development.  FETAL MEMBRANES AMNIOTIC FLUID A clear, straw-colored fluid in which the fetus floats. Origin: Initially from maternal serum or plasma but by the second half of pregnancy (10th week), fetal urination and swallowing contribute significantly to the volume of the amniotic fluid. Amount: 800 to 1,200 mL at term AMNIOTIC FLUID pH Level: Neutral to Alkaline (7 to 7.25) Functions: 1. Serves as a protective cushion/shock absorber. 2. Separates the fetus from membranes, allowing symmetrical growth & free movement 3. Acts as a medium of excretion. AMNIOTIC FLUID Functions: 4. Serves as a fetal drink. 5. Serves as a specimen for periodic diagnosis exams to determine fetal well-being or its absence 6. Maintain the fetal temperature 7. Equalizes uterine pressure and prevent marked interference with placental circulation during labor. ORIGIN & DEVELOPMENT OF ORGAN SYSTEMS STEM CELLS TOTIPOTENT STEM CELLS – Undifferentiated cells that have potential to grow into any cell in the human body. PLURIPOTENT STEM CELLS – Cells begins to differentiation to become any body cell. They are slated to become specific body cells. STEM CELLS MULTIPOTENT STEM CELLS – Cells so specific to become a particular body organ. ZYGOTE GROWTH Cephalocaudal (head-to-tail) - Head development occurs first, followed by the middle and finally the lower body parts. LAYERS OF THE BLASTOCYST ENDODERM: The inner layer; develops into: Linings of the GIT from the pharynx to the rectum Liver, pancreas, thyroid and parathyroid Respiratory tract Bladder and thymus (for immunity building) LAYERS OF THE BLASTOCYST ECTODERM: The outer layer; develops into: Nervous System Hair, nails, skin epidermis, sebaceous and sweat glands Salivary glands, and mucous membrane of the mouth Epithelium of nasal and oral passages. LAYERS OF THE BLASTOCYST MESODERM: The middle layer; develops into: Dermis Cardiovascular system Reproductive system Musculo – skeletal system Urogenital system, except the bladder STAGES OF EMBRYONIC PERIOD Gastrulation – formation of blastocyst layers: Ectoderm, Mesoderm & Endoderm Neurulation – formation of neural tissue Organogenesis – development of the organs INTRAUTERINE GROWTH & DEVELOPMENT AGE DEVELOPMENT 4 WEEKS All systems in the rudimentary form; beginning of eyes, nose and GIT. Partitioning of the primitive heart begins; heart chambers are formed; the heart beats (14 days); the heart is completely formed by the end of 6 weeks With arm and led buds By the end of the 4th week after ovulation, the chorionic sac is 2 to 3 cm in diameter, and the embryo is about 4 to 5 mm in length. INTRAUTERINE GROWTH & DEVELOPMENT AGE DEVELOPMENT 8 WEEKS Head size is large in proportion to the body, neuromuscular development and some movements. Rapid brain development External genitalia appear 12 WEEKS Placenta fully formed and functioning kidneys develop; secrete urine; centers of ossification in most bones With sucking and swallowing Gender distinguishable INTRAUTERINE GROWTH & DEVELOPMENT AGE DEVELOPMENT 12 WEEKS FHT detected by ultrasound Crown – rump fetal length is 6 to 7 cm – uterus just palpable above the symphysis pubis 16 WEEKS More human appearance Quickening felt by multigravida Meconium in the bowels External genitalia are obvious; gender correctly determined by experienced observers by inspection of the external genitalia at 14 weeks. INTRAUTERINE GROWTH & DEVELOPMENT AGE DEVELOPMENT 16 WEEKS Scalp hair develops Formed eyes, nose and ears FHT detected by fetoscope By the end of 16 weeks, crown – rump length is 12 cm, fetal weight is 110 g. 20 WEEKS Skin is less transparent With vernix caseosa and downy lanugo covering the entire body. Strong quickening felt by primigravida FHT is audible using stethoscope Bone hardening | Weight more than 300 g INTRAUTERINE GROWTH & DEVELOPMENT AGE DEVELOPMENT 24 WEEKS Weight about 630 g. Body well – proportioned Skin is red and wrinkled; fat deposition begins Hearing established Eyebrows and eyelashes are recognizable Canalicular period of lung development 28 WEEKS Weight: 1,100 g; Crown – rump length: about 25 cm. Viable; immature if born at this time; surfactant production begins. INTRAUTERINE GROWTH & DEVELOPMENT AGE DEVELOPMENT 28 WEEKS 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. INTRAUTERINE GROWTH & DEVELOPMENT AGE DEVELOPMENT 32 WEEKS More reflexes are present With iron and calcium storage Good chance of survival if delivered. 36 WEEKS Weight: 2,500 g: Crown – rump length: 32 cm; Lecithin/Sphyngomyelin ratio is 2:1 Nails firm With a definite sleep/wake pattern More rotund body because of subcutaneous fat deposition; lanugo disappearing Excellent chance of survival with proper care. INTRAUTERINE GROWTH & DEVELOPMENT AGE DEVELOPMENT 40 WEEKS Weight: approximately 3,400 g; Crown – rump length: 36 cm Full term, fully developed, with good muscle tone and reflexes Little lanugo If male, testes in the scrotum The age at the time of EDC counts from first day of LMP. With other characteristic features of the newborn. FETAL CIRCULATION FETAL IMMUNITY IMMUNOGLOBULIN (Ig) G: Maternal antibodies cross the placenta into the fetus as early as the 20th week and certainly by the 24th week of intrauterine life. It gives fetus a temporary passive immunity against diseases for which the mother has antibodies.  ASSESSMENT OF FETAL GROWTH & DEVELOPMENT FETAL ASSESSMENT Tests for fetal G&D are commonly done for a variety of reason, including: 1. Predict the outcome of the pregnancy. 2. Manage the remaining weeks of the pregnancy. 3. Plan for possible complications at birth. FETAL ASSESSMENT Test for fetal G&D are commonly done for a variety of reason, including: 4. Plan for problems that may occur in the newborn infant. 5. Decide whether to continue the pregnancy. 6. Find conditions that may affect future pregnancies. NURSING RESPONSIBILITIES 1. Obtain informed consent 2. Explain the procedure to the pregnant client and family members. 3. Prepare the client physically and emotionally. 4. Provide support during the procedure. 5. Assess fetal and maternal responses during and after the procedure 6. Provide any necessary follow up care. 7. Managing the equipment and specimens. NURSING HEALTH HISTORY 1. Ask client about any illnesses prior to pregnancy. 2. Ask about any medications she takes. 3. Ask about nutritional intake and personal habits. 4. Ask about her environmental exposure (teratogens). 5. Ask about her previous pregnancy. 6. Ask client about any exposure to communicable diseases such as COVID – 19. 7. Ask client about unintentional injuries or intimate partner violence. PHYSICAL EXAMINATION It is the second step in evaluating fetal health. Assessing maternal weight and general appearance can give clues about the nutritional and physical condition of the fetus. ASSESSING FETAL GROWTH & HEALTH FUNDIC HEIGHT MEASUREMENT: Over the symphysis pubis at 12 weeks At the umbilicus at 20 weeks At the xiphoid process at 36 weeks MCDONALD RULE: Measuring from the notch of the symphysis pubis to over the top of the uterine fundus (ideal for 20th to 31st weeks AOG. ASSESSING FETAL GROWTH & HEALTH MCDONALD RULE: ASSESSING FETAL GROWTH & HEALTH FETAL HEART RATE: Fetal heart sounds can be heard and counted as early as 10th to 11th week of pregnancy using Doppler ultrasound. KICK COUNTS: Fetal movement that can be felt by the pregnant person occurs at 18 to 20 weeks and it intensifies at 28 to 38 weeks. ASSESSING FETAL GROWTH & HEALTH RHYTHM STRIP TESTING: An assessment of fetal well – being and assesses the FHR for normal baseline rate. Help client into semi – fowler’s position. Attach an external fetal monitor Record the FHR for 20 minutes. ASSESSING FETAL GROWTH & HEALTH RHYTHM STRIP TESTING: Variability is rated as: Absent – No peak-to-trough range is detectable Minimal – An amplitude range is detectable, but the rate is 5 bpm or fewer. Moderate or Normal – An amplitude range is detectable; rate is 6 to 25 bpm. Marked – An amplitude range is detectable; rate is greater than 25 bpm. ASSESSING FETAL GROWTH & HEALTH RHYTHM STRIP TESTING: ASSESSING FETAL GROWTH & HEALTH NONSTRESS TESTING: Measure the response of FHR to fetal movement. Help client into a sitting position. Attach FHR and a uterine contraction monitor Instruct the client to push the button attached to the monitor whenever she feel the fetus move. ASSESSING FETAL GROWTH & HEALTH NONSTRESS TESTING: 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. ASSESSING FETAL GROWTH & HEALTH VIBROACOUSTIC STIMULATION: A specially designed acoustic stimulator is applied to the pregnant client’s abdomen to produce a sharp sound which startles and awakes the fetus. The sound is approximately 80 dB at 80 Hz in frequency. ASSESSING FETAL GROWTH & HEALTH VIBROACOUSTIC STIMULATION: Utilized together with nonstress test. 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. ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY: Measures the response of sound waves against solid objects, is a much-used tool for fetal health assessment. It can be used to: Diagnose pregnancy Establish a fetus is growing and has no gross anomalies. Establish the sex if penis is revealed. ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY: It can be used to: Establish the presentation and position of the fetus. Predict the gestational age by measurement of biparietal diameter of the head or the crown- rump measurement Discover complications of pregnancy Detect any retained placenta or poor uterine involution after birth. ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY Before the procedure: The patient has received a good explanation of what the procedure will be like. The patient has an assurance that the process does not involve X-rays and safe for the fetus. The patient should have a full bladder at the time of the procedure. ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY Before the procedure: Assist patient up to an examination table and drape them modesty with her abdomen exposed Place a towel under the right buttock to tip the body slightly. A gel to be applied must be at room temperature or slightly warmer. ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY The following are the specific features to be studied by sonogram: Biparietal Diameter – is measured to predict fetal maturity. ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY The following are the specific features to be studied by sonogram: Doppler Umbilical Velocimetry – measures the velocity at which RBCs in the uterine and fetal vessels travel. – Helpful to determine the vascular resistance present in patients with gestational diabetes or hypertension. ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY The following are the specific features to be studied by sonogram: Placental Grading – placentas can be graded based on the amount of calcium deposits present in the base. 0 – between 12 & 24 weeks 1 – 30 to 32 weeks 2 – 36 weeks 3 – 38 weeks ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY The following are the specific features to be studied by sonogram: Amniotic Fluid Volume – is measured to estimate the fetal health particularly the circulatory and kidney functions. Between 28 to 40 weeks, the total pockets of amniotic fluid ranges from 12 to 15 cm. ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY The following are the specific features to be studied by sonogram: Amniotic Fluid Volume ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY The following are the specific features to be studied by sonogram: Nuchal Translucency – Measures the amount of fluid behind the fetus neck during first trimester of pregnancy. Used to detect chromosomal anomalies such as Down Syndrome, Edwards Syndrome etc. ASSESSING FETAL GROWTH & HEALTH ULTRASONOGRAPHY The following are the specific features to be studied by sonogram: Biophysical Profile – This is to assess the overall fetal health. It is a combination of 5 parameters 1. Fetal breathing Often called 2. Fetal movement FETAL APGAR 3. Fetal tone SCORE 4. Amniotic fluid volume 5. Fetal heart reactivity ASSESSING FETAL GROWTH & HEALTH MAGNETIC RESONANCE IMAGING (MRI): It is used for fetal assessment to identify structural anomalies or soft tissue disorders. Most helpful in diagnosing complications such as ectopic pregnancy or trophoblastic disease. ASSESSING FETAL GROWTH & HEALTH MATERNAL SERUM ANALYSIS: Number of trophoblast cells pass into the maternal bloodstream beginning at about the 7th week. It can reveal information about the pregnant patient as well as the fetus. ASSESSING FETAL GROWTH & HEALTH MATERNAL SERUM ANALYSIS: ALPHA – FETOPROTEIN: It is used to check the fetus’ risk to birth defects and genetic disorders. PAPP - A: Protein secreted by the placenta. Low level in maternal blood are associated with chromosomal anomalies which high level may predict an LGA baby. ASSESSING FETAL GROWTH & HEALTH MATERNAL SERUM ANALYSIS: QUADRUPLE SCREENING: Analyses four indicators of fetal health. 1. APF 2. Unconjugated Estriol (UE) 3. hCG 4. Inhibin A ASSESSING FETAL GROWTH & HEALTH MATERNAL SERUM ANALYSIS: FETAL SEX: It is helpful to pregnant patient who has an X – carrying genetic disorders. ASSESSING FETAL GROWTH & HEALTH INVASIVE FETAL TESTING: It is helpful in getting a more accurate result. It has 99% reliability rate. 1. AMNIOCENTESIS 2. CHORIONIC VILLI SAMPLING 3. PERCUTANEOUS UMBILICAL BLOOD SAMPLING 4. FETOSCOPY ASSESSING FETAL GROWTH & HEALTH INVASIVE FETAL TESTING: 1. AMNIOCENTESIS A. AFP B. Acetylcholinesterase C. Bilirubin determination D. Chromosome Analysis E. Color F. Fibronectin G. Inborn error of metabolism ASSESSING FETAL GROWTH & HEALTH INVASIVE FETAL TESTING: 2. CHORIONIC VILLI SAMPLING: It is typically offered when there is a higher risk of genetic disorders, such as due to advanced maternal age, family history of genetic conditions, or abnormal results from screening tests like first trimester screening. ASSESSING FETAL GROWTH & HEALTH INVASIVE FETAL TESTING: 3. PERCUTANEOUS UMBILICAL BLOOD SAMPLING: It is the process of aspiration of blood from the umbilical vein for analysis. It is performed through amniocentesis technique ASSESSING FETAL GROWTH & HEALTH INVASIVE FETAL TESTING: 3. PERCUTANEOUS UMBILICAL BLOOD SAMPLING: Blood samples will be examined: CBC Direct Coombs test Blood gases Karyotyping ASSESSING FETAL GROWTH & HEALTH INVASIVE FETAL TESTING: 3. PERCUTANEOUS UMBILICAL BLOOD SAMPLING: Blood obtained will initially examine if it is fetal blood through Kleihauer – Betke test. Fetal heart rate and uterine contraction should be monitored before and after the procedure. ASSESSING FETAL GROWTH & HEALTH INVASIVE FETAL TESTING: 4. FETOSCOPY: The fetus is visualized by inspection through a fetoscope This method allows direct visualization of both the amniotic fluid and fetus. ASSESSING FETAL GROWTH & HEALTH INVASIVE FETAL TESTING: 4. FETOSCOPY: The main reasons the procedure is used are to: 1. Confirm the intactness of the spinal column. 2. Obtain biopsy samples of fetal tissue and blood. 3. Determine meconium staining 4. To perform elemental surgery ASSESSING FETAL GROWTH & HEALTH INVASIVE FETAL TESTING: 4. FETOSCOPY  PREGNANT PATIENT S WITH UNIQUE NEEDS OR CONCERNS PREGNANT PATIENTS WITH UNIQUE NEEDS AND CONCERNS 1. Obese patients 2. Difficulty in mobilization 3. Patient with hearing disability 4. Patient with visual disability THANK YOU