Human Sexuality A. Concepts 1. A person’s sexuality encompasses the complex behaviors, attitudes emotions and preferences that are related to sexual self and eroticism. 2. Sex – basic and dynamic aspect of life 3. During reproductive years, the nurse performs as resource person on human sexuality. B. Definitions related to sexuality: Gender identity – sense of femininity or masculinity 2-4 yrs/3 yrs gender identity develops. Role identity – attitudes, behaviors and attributes that differentiate roles Sex – biologic male or female status. Sometimes referred to a specific sexual behavior such as sexual intercourse. Sexuality - behavior of being boy or girl, male or female man/ woman. Entity life long dynamic change. - developed at the moment of conception. II. Sexual Anatomy and Physiology A. Female Reproductive System 1. External value or pretender a. Mons pubis/veneris - a pad of fatty tissues that lies over the symphysis pubis covered by skin and at puberty covered by pubic hair that serves as cushion or protection to the symphysis pubis. Stages of Pubic Hair Development Tannerscale tool - used to determine sexual maturity rating. Stage 1 – Pre-adolescence. No pubic hair. Fine body hair only Stage 2 – Occurs between ages 11 and 12 – sparse, long, slightly pigmented & curly hair at pubis symphysis Stage 3 occurs between ages 12 and 13 – darker & curlier at labia Stage 4 – occurs between ages 13 and 14, hair assumes the normal appearance of an adult but is not so thick and does no appear to the inner aspect of the upper thigh. Stage 5 sexual maturity- normal adult- appear inner aspect of upper thigh . b. Labia Majora - large lips longitudinal fold, extends symphisis pubis to perineum c. Labia Minora – 2 sensitive structures clitoris- anterior, pea shaped erectile tissue with lots sensitive nerve endings sight of sexual arousal (Greek-key) fourchette- Posterior, tapers posteriorly of the labia minora- sensitive to manipulation, torn during delivery. Site – episiotomy. d. Vestibule – an almond shaped area that contains the hymen, vaginal orifice and bartholene’s glands. Urinary Meatus – small opening of urethra, serves for urination Skenes glands/or paraurethral gland – mucus secreting subs for lubrication hymen – covers vaginal orifice, membranous tissue vaginal orifice – external opening of vagina bartholene’s glands- paravaginal gland or vulvo vaginal gland -2 small mucus secreting subs – secrets alkaline subs. Alkaline – neutralizes acidity of vagina Ph of vagina - acidic Doderleins bacillus – responsible for acidity of vagina Carumculae mystiformes-healing of torn hymen e. Perineum – muscular structure – loc – lower vagina & anus Internal: A. vagina – female organ of copulation, passageway of mens & fetus, 3 – 4inches or 8 – 10 cm long, dilated canal Rugae – permits stretching without tearing B. uterus- Organ of mens is a hollow, thick walled muscular organ. It varies in size, shape and weights. 1. 2. 3. 4. 5.
Size- 1x2x3 Shape: nonpregnant pear shaped / pregnant - ovoid Weight - nonpregnant – 50 -60 kg- pregnant – 1,000g Pregnant/ Involution of uterus: 4th stage of labor - 1000g 2 weeks after delivery - 500g 3 weeks after delivery - 300 g 5-6 weeks after delivery - returns to original, state 50 – 60 Three parts of the uterus 1. fundus - upper cylindrical layer 2. corpus/body - upper triangular layer 3. cervix - lower cylindrical layer * Isthmus lower uterine segment during pregnancy Cornua-junction between fundus & interstitial Muscular compositions: there are three main muscle layers which make expansion possible in every direction. 1. Endometrium- inside uterus, lines the nonpregnant uterus. Muscle layer for menstruation. Sloughs during menstruation. Decidua- thick layer. Endometriosis-proliferation of endometrial lining outside uterus. Common site: ovary. S/sx: dysmennorhea, low back pain. Dx: biopsy, laparoscopy Meds: 1. Danazole (Danocrene) a. to stop mens b. inhibit ovulation 2. Lupreulide (Lupron) –inhibit FSH/LH production 2. Myometrium – largest part of the uterus, muscle layer for delivery process • Its smooth muscles are considered to be the living ligature of the body. - Power of labor, resp- contraction of the uterus 3. Perimetrium – protects entire uterus C. ovaries – 2 female sex glands, almond shaped. Ext- vestibule int – ovaries Function: 1. ovulation 2. Production of hormones d. Fallopian tubes – 2-3 inches long that serves as a passageway of the sperm from the uterus to the ampulla or the passageway of the mature ovum or fertilized ovum from the ampulla to the uterus. 4 significant segments 1. Infundibulum – distal part of FT, trumpet or funnel shaped, swollen at ovulation 2. Ampulla – outer 3rd or 2nd half, site of fertilization 3. Isthmus – site of sterilization – bilateral tubal ligation 4. Interstitial – site of ectopic pregnancy – most dangerous B. Male Reproductive System 1. External penis – the male organ of copulation and urination. It contains of a body of a shaft consisting of 3 cylindrical layers and erectile tissues. At its tip is the most sensitive area comparable to that of the clitoris in the female – the glands penis. 3 Cylindrical Layers 2 corpora cavernosa 1 corpus spongiosum Scrotum – a pouch hanging below the pendulous penis, with a medial septum dividing into two sacs, each of which contains a testes. - cooling mechanism of testes < 2 degrees C than body temp. Leydig cell – release testosterone
2. Internal The Process of Spermatogenesis – maturation of sperm
Blank! Can’t erase!
Testes – 900 coiled (½ meter long at age 13 onwards) (Seminiferous tubules)
Epididymis – 6 meters coiled tubules site for maturation of sperm
GnRH Ant Pit Gland
Vas Deferens – conduit for spermatozoa or pathway of sperm
Seminal vesicle – secretes: 1.) Fructose – glucose has nutritional value. 2.) Prostaglandin – causes reverse contraction of uterus
Fx: Sperm Maturation
Fx: Hormones for Testosterone Production
Ejaculatory duct – conduit of semen
Prostate gland- secrets alkaline substance Cowpers gland secrets alkaline substance
Male and Female homologues Male Penile glans Penile shaft Testes Prostate Cowper’s Glands Scrotum Female Clitoral glans Clitorial shaft ovaries Skene’s gands Bartholin's glands Labia Majora
3 – 5 days Normal Blood loss – 50cc or ¼ cup Related terminologies: Menarche – 1st mens Dysmenorrhea – painful mens Metrorrhagia – bleeding between mens Menorhagia – excessive during mens Amenorrhea – absence of mens Menopause – cessation of mens/ average : 51 years old 9. Sperm is viable within 48 – 72 hrs. mammary gland development 4. DNA – carries genetic code 2. causes mood swings in moms 6. increase in height in female 7. Ovum is capable of being fertilized with in 24 – 36 hrs after ovulation 5. development ductile structure of breast 5. hypothalamus 2. Menses Parts of body responsible for mens: 1. causes early closure of epiphysis of long bones 8. Age of Reproductivity – 15 – 44yo 8. Ischemic 4. Spinnbarkeit & Ferning ( billings method/ cervical) 4. increase BBT 10. Phases of Menstrual Cycle: 1. anterior pituitary gland – master clock of body
. hypertrophy of myometrium 3. Secretory 3. Functions of Estrogen and Progestin * Estrogen “Hormone of the Woman” – Primary function: development secondary sexual characteristic female.III. increase osteoblast activities of long bones 6. Chromosomes – threadlike strands composed of hereditary material – DNA 3.inhibit prod of LH (hormone for ovulation) 2. Reproductive cells divides by the process of meiosis (haploid) Spermatogenesis – maturation of sperm Oogenesis – process .. increase permeability of kidney to lactose & dextrose causing (+) sugar 5. Others: 1. increase sexual desire *Progestin “ Hormone of the Mother” Primary function: prepares endometrium for implantation of fertilized ovum making it thick & tortous (twisted) Secondary Function: uterine contractility (favors pregnancy) Others: 1. Proliferative 2. Menstrual Cycle 4 phases of Menstrual Cycle 1. Basic Knowledge on Genetics and Obstetrics 1. causes sodium retention 9.inhibit motility of GIT 3. 1 tsp 4. 2-3 days 6. inhibit production of FSH ( maturation of ovum) 2.maturation of ovum Gematogenesis – formation of 2 haploid into diploid 23 + 23 = 46 or diploid 7. MenstruationMenstrual Cycle – beginning of mens to beginning of next mens Average Menstrual Cycle – 28 days Average Menstrual Period . Normal amount of ejaculated sperm 3 – 5 cc.
24th day if no fertilization. after ovulation day. Plateau Phase – (accelerated V/S) – increasing & sustained tension nearing orgasm. hormone for ovulation VI. corpus luteum degenerate ( whitish – corpus albicans) X.
IV. Lasts 30 seconds – 3 minutes.
2. long tail. sex flush. the estrogen level is decreased.) Change in BBT. (13th day-decreased progesterone) LH stimulates ovaries to release progesterone 2. 5
. post mens phase.) III. Capacitation. VII. 15th day. pearly white Phonones-vibration of head of sperm to determine location of ovum Sperm should penetrate corona radiata and zona pellocida.small head. marks ovulation day. ovaries 4. 14th day estrogen level is increased while the progesterone level is increased causing rupture of graffian follicle on process of ovulation.where sperm is deposited Sperm. Pre-ovularoty. Stimulate ovaries to release estrogen 2. RR. this level stimulates the hypothalamus to release GnRH or FSHRF II. 2. graafian follicle starts to degenerate yellowish known as corpus luteum (secrets large amount of progesterone) VIII.)
IX. Facilitate growth primary follicle to become graffian follicle (secrets large amt estrogen & contains mature ovum. mood swing GnRF/LHRF stimulates the ant pit gland to release LH.ability of sperm to release proteolytic enzyme to penetrate corona radiata and zona pellocida. -phase of increase estrogen. Excitement Phase – (sign present in both sexes. increase progesterone I. Proliferative Phase – proliferation of tissue or follicular phase. estrogen level is peak while the progesterone level is down.BP. nipple erection) – erotic
stimuli cause increase sexual tension. On the initial 3rd phase of menstruation .
1. these stimulates the hypothalamus to release GnRF on LHRF Mittelschmerz – slight abdominal pain on L or RQ of abdomen. Functions of LH: 1. Stages of Sexual Responses (EPOR) Initial responses: Vasocongestion – congestion of blood vessels Myotonia – increase muscle tension
1. Secretory phaseLutheal Phase Postovulatory Phase Premenstrual Phase V. moderate increase in HR. Follicular Phase – causing irregularities of mens Postmenstrual Phase Preovulatory Phase – phase increase estrogen 13th day of menstruation. 11.3. lasts minutes to hours. increase progesterone 15th day – Decrease estrogen. 28th day – if no sperm in ovum – endometrium begins to slough off to begin mens
Fornix. GnRH/FSHRF – stimulates the anterior pituitary gland to release FSH Functions of FSH: 1. uterus Initial phase – 3rd day – decreased estrogen 13th day – peak estrogen. decrease progesterone 14th day – Increase estrogen.
May last 2 – 10 sec. Zygote. Apposition 2. with crystallized forming pattern. Done early in pregnancy.10 – 11th day. 3 processes of Implantation 1. slightly alkaline.
4. maintains temp
. 15 – 55cm. immeasurable peak of sexual experience.occurs after fertilization 7 – 10 days. 4 days free floating & multiplication c.fertilized ovum. placenta previa – implantation at low side of uterus Signs of implantation: 1. Invasion C. Fertilization B. Blastocyst – enlarging cells that forms a cavity that later becomes the embryo. clear. Chorionic Villi. *Function of Amniotic Fluid: 1. Lifespan of zygote – from fertilization to 2 months b. facilitates musculo-skeletal development 3. might get infected syphilis F. Long cord:cord coil or cord prolapse b. Resolution – (v/s return to normal.FUNIS. cushions fetus against sudden blows or trauma 2. Synsitiotrophoblast – synsitial layer – responsible production of hormone 1.
C. E. genitals return to pre-excitement phase) Refractory Period – the only period present in males. Blastocyst – covering of blastocys that later becomes placenta & trophoblast d. peak v/s) involuntary release of sexual tension with physiologic or
psychologic release. slight pain 2. whitish grey. Before 24 weeks critical. Stages of Fetal Growth and Development 3-4 days travel of zygote – mitotic cell division begins *Pre-embryonic Stage a. Amniotic Fluid – bag of H2O. 20 – 21”. Common complication fetal limb defect. Umbilical Cord. Decidua – thickened endometrium ( Latin – falling off) * Basalis (base) part of endometrium located under fetus where placenta is delivered * Capsularies – encapsulate the fetus * Vera – remaining portion of endometrium. Cytotrophoblast – inner layer or langhans layer – protects fetus against syphilis 24 wks/6 months – life span of langhans layer increase. Fetus. finger life projections
3 vessels= A – unoxygenated blood V – O2 blood A – unoxygenated blood Wharton’s jelly – protects cord Chorionic villi sampling (CVS) – removal of tissue sample from the fetal portion of the developing placenta for genetic screening. Implantation/ Nidation.3. odor mousy/musty. Short cord: abruptio placenta or inverted uterus. Morula – mulberry-like ball with 16 – 50 cells. Adhesion 3.2 months to birth. Amnion – inner most layer a. Orgasm – (involuntary spasm throughout body. Ex missing digits/toes.most affected are is pelvic area.if with fertilization – corpus luteum continues to function & become source of estrogen & progesterone while placenta is not developed. slight vaginal spotting . wherein he cannot be restimulated for about 10-15 minutes
Endocrine System – produces hormones • Human Chorionic Gonadrophin – maintains corpus luteum alive.needle insertion site Aspiration of yellowish amniotic fluid – jaundice baby Greenish – meconium A. hydramnios.
4.4. combination of chorionic villi + deciduas basalis. B. Circulating system – achieved by selective osmosis
5. Simple diffusion
2. Genetic screening. If mom
1. increased amt of fluid oligohydramnios. Liver of mom detoxifies fetus. Determination of fetal maturity primarily by evaluating factors indicative of lung maturity – 3rd trimester Testing time – 36 weeks decreased MSAFP= down syndrome increase MSAFP = spina bifida or open neural tube defect Common complication of amniocenthesis – infection Dangerous complications – spontaneous abortion 3rd trimester.GIT malformation TEF/TEA. Size: 500g or ½ kg
-1 inch thick & 8” diameter Functions of Placenta: 1. prevent cord compression 5.determine if amniotic fluid has ruptured or not (blue paper turns green/grey . Purpose – obtain a sample of amniotic fluid by inserting a needle through the abdomen into the amniotic sac.+ ruptured amniotic fluid) C. Placenta – (Secundines) Greek – pancake. Chorion – where placenta is developed
Lecithin Sphingomyelin L/S Ratio.carries waste products.artery . Nitrazine Paper Test – diff amniotic fluid & urine. glucose transport is facilitated. Paper turns blue green/gray-(+) rupture of amn fluid. diffusion more rapid from higher to lower.maternal serum alpha feto-protein test (MSAFP) – 1st trimester 2.decrease amt of fluid – kidney disease Diagnostic Tests for Amniotic Fluid A. GIT – transport center. Fern Test. fluid is tested for: 1. Excretory System. Paper turns yellow.pre term labor Important factor to consider for amniocentesis. fetus hypoglycemic 3. Amnioscopy – direct visualization or exam to an intact fetal membrane.urine. help in delivery process
normal amt of amniotic fluid – 500 to 1000cc polyhydramnios.2:1 signifies fetal lung maturity not capable for RDS Shake test – amniotic + saline & shake Foam test Phosphatiglyceroli: PG+ definitive test to determine fetal lung maturity
a. Respiratory System – beginning of lung function after birth of baby. Amniocentesis empty bladder before performing the procedure.
1. Fetal heart tone heard – Doppler – 10 – 12 weeks 4.
Fetal Stage “ Fetal Growth and Development” Entire pregnancy days – 266 – 280 days 37 – 42 weeks Differentiation of Primary Germ layers * Endoderm 1st week endoderm – primary germ layer Thyroid – for basal metabolism Parathyroid . musculoskeletal system. skin and senses. 18 – 20 weeks buds of permanent teeth appear Fifth Month lanugo covers body actively swallows amniotic fluid 19 – 25 cm fetus.
3. Meconium is formed Third Month 1. Sex is distinguishable Second Trimester: FOCUS – length of fetus 1.18 wks – multi fetal heart tone heard with or without instrument Sixth Month eyelids open wrinkled skin vernix caseosa present
2. placenta developed 2. kidneys and repro organ * Ectoderm – development of brain. 18.causes softening joints & bones estrogen progestin
It serves as a protective barrier against some microorganisms – HIV.
.20 weeks primi. CNS develops – dizziness of mom due to hypoglycemic effect Food of brain – glucose complex CHO – pregnant womans food (potato) Second Month 1. 2.Brain & heart development GIT& resp Tract – remains as single tube 1.1st fetal movement. Has a diabetogenic effect – serves as insulin antagonist Relaxin Hormone. hair. Fourth Month lanugo begins to appear fetal heart tone heard fetoscope. All vital organs formed. Buds of milk teeth appear 3. Sex organ formed 4. mucus membrane or anus & mouth First trimester: 1st month . 3. Fetal heart tone begins – heart is the oldest part of the body 2. nails.• • • • 6. Corpus luteum – source of estrogen & progesterone of infant – life span – end of 2nd month 3. 2. Quickening. Kidneys functional 2.for calcium Thymus – development of immunity Liver – lining of upper RT & GIT * Mesoderm – development of heart. 16. 3.
Human placental Lactogen or sommamommamotropin Hormone – for mammary gland development. 1.
inhibit growth of long bone Vitamin K – hemolysis (destr of RBC). Systemic Changes 1. D. Hepa A or infectious heap – oral/ fecal (hand washing) Hepa B. HIV – blood & body fluids Syphilis R – rubella – German measles – congenital heart disease (1st month) normal rubella titer 1:10 <1:10 – less immunity to rubella. influenza like findings. virus or irradiation. increase heart workload. In some chases the infection may go unnoticed in the pregnant woman yet have devastating effects on the fetus.any drug. mom will be given rubella vaccine. FOCUS: weight of fetus Seventh Month – development of surfactant – lecithin 1. 2. slight hypertrophy of ventricles. fetal alcohol withdrawal syndrome char by microcephaly Smoking – low birth rate Caffeine – low birth rate Cocaine – low birth rate. hyperbilirubenia or jaundice Iodides – enlargement of thyroid or goiter Thalidomides – Amelia or pocomelia. enlarged lymph nodes. Rubella.
TORCH (Teratogenic) Infections – viruses CHARACTERISTICS: group of infections caused by organisms that can cross the placenta or ascend through birth canal and adversely affect fetal growth and development. 3. epistaxis – due to hyperemia of nasal membrane palpitation. Other. Physiological Adaptation of the Mother to Pregnancy
A. C. Vaccine is teratogenic C – cytomegalo virus H – herpes simplex virus I. T – toxoplasmosis – mom takes care of cats. the exposure to such may cause damage to the fetus A.easy fatigability. after delivery. These infections are often characterized by vague. Don’t get pregnant for 3 months. abruption placenta
1. Cytomegalo virus. rashes and lesions. Eighth Month lanugo begin to disappear sub Q fats deposit Nails extend to fingers Ninth Month lanugo & vernix caseosa completely disappear Amniotic fluid decreases Tenth Month – bone ossification of fetal skull Terratogens.
B.Third trimester: Period of most rapid growth. TORCH: Toxoplasmosis. 2. Cardiovascular System – increase blood volume of mom (plasma blood) 30 – 50% = 1500 cc of blood . Physiologic Anemia – pseudo anemia of pregnant women Normal Values
. Herpes simples virus. E. Drugs: Streptomycin – anti TB & or Quinine (anti malaria) – damage to 8th cranial nerve – poor hearing & deafness Tetracycline – staining tooth enamel. and jaundice (hepatic involvement). absence of extremities Steroids – cleft lip or palate Lithium – congenital malformation Alcohol – lowered weight (vasoconstriction on mom). Feces of cat go to raw vegetables or meat O – others.
It affects toughly 20% of pregnant women. Z tract. black stool.Hct Hgb Criteria
32 – 42% 10. protamine sulfate Avoid aspirin! Might aggravate bleeding. ampalaya • Parenteral Iron ( Imferon) – severe anemia.3 g.if improperly administered. avoid wearing knee high socks . pressure on gravid uterus.position – side lying with pillow under hips or modified knee chest position Thrombophlebitis – presence of thrombus at inflamed blood vessel . 3 times a day) empty stomach 1 hr before meals or 2 hrs after.pathologic anemia if lower HCT should not be 33%.5% pathologic anemia if lower Pathogenic Anemia Iron deficiency anemia is the most common hematological disorder.) 5.) Bed rest Never massage Assess + Homan sign once only might dislodge thrombus Give anticoagulant to prevent additional clotting (thrombolytics will dilute) Monitor APTT antidote for Heparin toxicity.increase fibrinogen .) 4.increase clotting factor .pregnant mom hyperfibrinogenemia .5 – 14g/dL
1st and 3rd trimester. malunggay. Assessment reveals: • Pallor..painful.thrombus formation candidate Outstanding sign – (+) Homan's sign – pain on cuff during dorsiflexion Milk leg – skinny white legs due to stretching of skin caused by inflammation or phlagmasia albadolens Mgt: 1. constipation • Slowed capillary refill • Concave fingernails (late sign of progressive anemia) due to chronic physio hypoxia Nursing Care: • Nutritional instruction – kangkong. green leafy vegetable-alugbati.use elastic bandage – lower to upper Vulbar varicosities.
2. to relieve. liver due to ferridin content. Varicosities – pressure of uterus .) 3.) 2. horseradish. elevate legs above hip level. Respiratory system – common problem SOB due to enlarged uterus & increase O2 demand 10
. hematoma. constipation • Monitor for hemorrhage Alert: • • Iron from red meats is better absorbed iron form other sources Iron is better absorbed when taken with foods high in Vit C such as orange juice Higher iron intake is recommended since circulating blood volume is increased and heme is required from production of RBCs
Edema – lower extremities due venous return is constricted due to large belly. Hgb should not be < 11g/dL 2nd trimester – Hct should not <32% Hgb Shdn't < 10.) 6.saluyot. give IM.use support stockings. • Oral Iron supplements (ferrous sulfate 0.
Gastrointestinal – 1st trimester change •
Morning Sickness – nausea & vomiting due to increase HCG. . Ca & phosphorous imbalance(#1 cause while pregnant). brocolli.lateral expansion of lungs or side lying position. lobster. avoid 3 full meals. Increase fluid intake. Nausea afternoon . apple with skin. pineapple. proper body mechanical increase salivation – ptyalsim – mgt mouthwash *Hemorrhoids – pressure of gravid uterus. crab. Metabolic alkalosis. Local Changes Local change: Vagina: V – Chadwick’s sign – blue violet discoloration of vagina C – Goodel's sign – change of consistency of cervix I – Hegar's – change of consistency of isthmus (lower uterine segment) LEUKORRHEA – whitish gray. cantaloupe. seafood-tahong (mussels). Monitor I&O
constipation – progesterone resp for constipation. malungay. Cheese.fruits – papaya. Vomiting in preg – emesisgravida. Vaginitits – trichomonas vaginalis due to alkaline environment of vagina of pregnant mom Flagellated protozoa – wants alkaline S&Sx: Greenish cream colored frothy irritatingly itchy with foul smelling odor with vaginal edema
. Vit D for increased Ca absorption dorsiflexion B. Musculoskeletal
Lordosis – pride of pregnancy Waddling Gait – awkward walking due to relaxation – causes softening of joints & bones Prone to accidental falls – wear low heeled shoes Leg Cramps – causes: prolonged standing. Dilis.Position. avoid fatty & spicy food. Eat dry crackers or dry CHO diet 30 minutes before arising bed. chills. mango.exercise -mineral oil – excretion of fat soluble vitamins * Flatulence – avoid gas forming food – cabbage * Heartburn – or pyrosis – reflux of stomach content to esophagus .small frequent feeding. head of fish. hot sitz bath for comfort
4. over fatigue.small freq feeding. increase fiber diet . resp for leucorrhea OPERCULUM – mucus plug to seal out bacteria. yogurt. Mgt. suha. pressure of gravid uterus (labor cramps) at lumbo sacral nerve plexus Mgt: Increase Ca diet-milk(Inc Ca & Inc phosphorus)-1pint/day or 3-4 servings/day. oversex. sips of milk. Urinary System – frequency during 1st & 3rd trimester lateral expansion of lungs or side lying pos – mgt for nocturia
Acetyace test – albumin in urine Benedicts test – sugar in urine 5. sardines with bones. watermelon. PROGESTERONE – hormone responsible for operculum PREGNANT – acidic to alkaline change to protect bacterial growth (vaginitis) Problems Related to the Change of Vaginal Environment: a. F&E imbalance – primary med mgt – replace fluids. mousy odor discharge ESTROGEN – hormone.
3. Except guava – has pectin that’s constipating – veg – petchy.
Skin Changes – brown pigmentation nose chin. cheeks – chloasma melasma due to increased melanocytes.symphisis pubis to umbilicus 4.ultrasound – full bladder placental grading – rating/grade o – immature 1 – slightly mature 2 – moderately mature 3 – placental maturity What is deposited in placenta which signify maturity . Ovaries – rested during pregnancy Signs & symptoms of Pregnancy Subjective
A. Carcinogenic drug so don’t give at 1st trimester 1. color of areola & nipple pre colostrums present by 6 weeks.change of consistency of isthmus Amenorrhea Elevated BBT – due to increased progesterone
Positive Ultrasound evidence (sonogram) full bladder Fetal heart tone
. mammography – 35 to 49 yrs once every 1 to 2 yrs 50 yrs and above – 1 x a yr 6.there is calcium Presumptive Probable Breast changes Goodel's. fungal infection. Positive Signs – undeniable signs confirmed by the use of instrument. use coconut oil. umbilicus is protruding
3. Objective C. colostrums at 3rd trimester Breast self exam. canesten Gonorrhea -Thick purulent discharge Vaginal warts.
Color – white cheese like patches adheres to walls of vagina.condifoma acuminata due to papilloma virus Mgt: cauterization 2. Breast Changes – increase hormones. Abdominal Changes – striae gravidarium (stretch marks) due enlarging uterus-destruction of sub Q tissue – avoid scratching. 7.Mgt: FLAGYL – (metronidazole – antiprotozoa).
Brown pinkish line. genshan violet. treat dad also to prevent reinfection 2. B.
Ballotment sign of myoma * + HCG – sign of H mole . no alcohol – has antibuse effect VAGINAL DOUCHE – IQ H2O : 1 tbsp white vinegar
b. cotrimaxole. Presumptive – s/s felt and observed by the mother but does not confirm positive diagnosis of pregnancy . Signs & Symptoms: Management – antifungal – Nistatin.7 days after mens –– supine with pillow at back quadrant B – upper outer – common site of cancer Test to determine breast cancer: 1. Moniliasis or candidiasis due to candida albecans.trans vaginal ultrasound.blue violet discoloration of vagina Fatigue Hegar's. Probable – signs observed by the members of health team. Empty bladder .linea nigra.change of consistency of cervix Urinary freq Chadwick’s.
monitor wt. age of viability . denial – sign of maladaptation to pregnancy.Morning sickness Enlarged uterus Cloasma Linea negra Increased skin pigmentation Striae gravidarium Quickening
Positive HCG or (+)preg test Ballottement – bouncing of fetus when lower uterine is tapped sharply Enlarged abdomen Braxton Hicks contractions – painless irregular contractions
Fetal movement Fetal outline Fetal parts palpable
VI. Personal data – name. (increase wt – 1st sign preeclampsia) Weight Monitoring First Trimester: Normal Weight gain Second trimester: normal weight gain Third trimester: normal weight gain Minimum wt gain – 20 – 25 lbs Optimal wt gain – 25 – 35 lbs 1. Developmental task is to accept biological facts of pregnancy Focus: bodily changes of preg. mom identifies fetus as a separate entity – due to presence of quickening.
Psychological Adaptation to Pregnancy (Emotional response of mom –Reva Rubin theory) First Trimester: No tanginal signs & sx. BP. age (high risk < 18 & >35 yrs old) record to determine high risk – HBMR.# of viable pregnancy Viability – the ability of the fetus to live outside the uterus at the earliest possible gestational age. nutrition Second Trimester – tangible S&Sx.# of pregnancy b. Third Trimester: .best to get urine exam. Pre-Natal Visit: 1. religion.) urine exam to detect HCG at 40 – 100th day.
5. Frequency of Visit:
1st 7 months – 1x a month 8 – 9 months – 2 x a month 10 – once a week post term 2 x a week 2. 6 weeks after LMP.) Home preg kit – do it yourself Baseline Data: V/S esp.5 – 3 lbs 10 – 12 lbs 10 – 12 lbs (.) Elisa test – test for preg detects beta subunit of HCG as early as 7 – 10days 3. Diagnosis of Pregnancy 1. Health teaching: growth & development of fetus. Obstetrical Data: nullipara – no pregnancy a. Gravida.
. 2. Developmental task – accept growing fetus as baby to be nurtured. surprise. fantasy. Home base mom’s record. culture & beliefs with respect. 60 – 70 day peak HCG. civil status.20 – 24 wks Term 37 – 42 wks. Sex ( pseudocyesis or false pregnancy on men & women) Couvade syndrome – dad experiences what mom goes through – lihi) Address. ambivalence. non judgmental Occupation – financial condition or occupational hazards. HT: responsible parenthood ‘baby’s Layette” – best time to do shopping. education background – level knowledge 3.mom has personal identification on appearance of baby Development task: prepare of birth & parenting of child. Most common fear – let mom listen to FHT to allay fear Lamaze classes VII.5 – 1lb/month) (4 lbs/month) (1 lb/wk) (4 lbs/ month) ( 1lb/wk)
4. Para .
Formula: 1st ½ of preg . Important Estimates:
GP GTPAL 6 4 6 2 2 15
1.1 add 1 month to month 11/31/04 EDD LMP – Jan Feb Mar +9 +7 no year
2. McDonald’s Rule – to determine age of gestation IN WEEKS
FUNDIC HT X 7/8=AOG in WK Fundic Ht X 7 = AOG in weeks 8 Fr sypmhisis pubis to fundus 24 X 7 =21 wks 8 3. Nagele’s Rule – use to determine expected date of delivery
Get LMP -3+ 7 +1 Apr-Dec M D Y LMP Jan 25. Bartholomew’s Rule – to determine age of gestation by proper location of fundus at abdominal cavity.Preterm -20 – 37 weeks abortion <20 weeks Sample Cases: 1 – abortion GTPAL 1 – 2nd mo 2 0 01 0 G–2 P–0 1 – 40th AOG 1 – 36th AOG 2 – misc 1 – twins 1 – 4th month GT P A L 612 2 4 35 AOG G6 P3 GP GTPAL 4 2 4 11 1 1
1 – 39th week 1 – miscarriage 1 – stillbirth 33 AOG (considered as para) 1 – preg 3rd wk 1 – 33 P 1 41st L 1 – abort A 1 – still 39 1 triplet 32 1 4th mon c. 3 months – above sym pub 5 months – level of umbilicus 9 months – below zyphoid 10 months – level of 8 months due to lightening
4. Haases rule – to determine length of the fetus in cm. x @ month by 5 3mos x 3 = 9cm 4 mos x 4 = 16 cm 10 x 5 = 50 cm 1st ½ of preg 5 x 5 = 25 cm
6 x 5 = 30 cm
. square @ month 2nd ½ of preg. 04 +9 +7 10 / 32 / 04 .
E – edema to upper ext.
2nd ½ of preg
tetanus immunizations – prevents tetanus neonatum -mom with complete 3 doses DPT young age considered as TT1 & 2. (preeclampsia) Pelvic Examination – internal exam 1. Leopold’s Maneuver Purpose: is done to determine the attitude.cancer extends to vagina 3 – pelvis metastasis 4 – affection to bladder & rectum 7. empty bladder 2. fetal back & fetal heart tone . Prep mom: 6.use palm! Warm palm. Examine teeth: sign of infection Danger signs of Pregnancy C . ectopic pre/2nd – H mole. universal precaution EXT OS of cervix – site for getting specimen Site for cervical cancer Pap Smear – cervical cancer . Class III – cytology suggestive of malignancy Class IV – cytology strongly suggestive of malignancy Class V – cytology conclusive of malignancy Stages of Cervical Cancer Stage 0 – carcinoma insitu 1 – cancer confined to cervix 2 . and number of fetuses.
. Begin TT3
TT1 – any time during pregnancy TT2 – 4 wks after TT1 – 3 yrs protection TT3 – 6 months after TT2 – 5 yrs protection TT4 – 1 yr after TT3 – 10 yrs protection TT5 – yr after TT4 – lifetime protection 5. presenting part. incompetent cervix 3rd – placental anomalies S – sudden gush of fluid – PROM (premature rupture of membrane) prone to inf. degree of descent. an estimate of the size.composed of squamous columnar tissue Result: Class I .7 x 5 = 35 cm 8 x 5 = 40 cm 9 x 5 = 45 cm d. abortion.chills/ fever . fetal presentation lie.infection Cerebral disturbances ( headache – preeclampsia) A – abdominal pain ( epigastric pain – aura of impending convulsions B – boardlike abdomen – abruption placenta Increase BP – HPN Blurred vision – preeclampsia Bleeding – 1st trimester.normal Class IIA – acytology but no evidence of malignancy B – suggestive of infl. Physical Examination: A. position.
put towel under head and right hip. Nonstress test – to determine the response of the fetal heart rate to activity Indication – pregnancies at risk for placental insufficiency Postmaturity a. Assess whether the presenting part is engaged in the pelvis )Alert : if the head is engaged it will not be movable). often require further testing.) more then 1 hour to reach 10 movements b. movement and firmness of the part to determine presentation 2nd Maneuver: with both hands moving down. Assess size.) longer time to reach 10 FMs than on previous days d. Attach external noninvasive fetal monitors 1.) warning signs noted during DFMC c. Get V/S(before 2nd maneuver) PR to diff fundic soufflé (FHR) & uterine soufflé. noting how long it takes to count 10 fetal movements (FMs) (2) Expected findings – 10 movements in 1 hour or less 3) Warning signs a. Examples: nonstress test (NST). Uterine soufflé – maternal H rate 3rd Maneuver: using the right hand. identify the back of the fetus ( to hear fetal heart sound) where the ball of the stethoscope is placed to determine FHT.< 3 FMs in 12 hours 4.) movement are becoming weaker.Assessment of Fetal Well-BeingA. tocotransducer over fundus to detect uterine contractions and fetal movements (FMs) 2. such as a CST Result:
.fetal distress) c. To determine degree of engagement. grasp the symphis pubis part using thumb and fingers.1. the head will be flexed and vertex presenting. To determine attitude – relationship of fetus to 1 another. monitor until at least 2 FMs are detected in 20 minutes • if no FM after 40 minutes provide woman with a light snack or gently stimulate fetus through abdomen • if no FM after 1 hour further testing may be indicated.
Empty bladder Position of mom-supine with knee flex (dorsal recumbent – to relax abdominal muscles)
Procedure: 1st maneuver: place patient in supine position with knees slightly flexed. ultrasound transducer over abdominal site where most distinct fetal heart sounds are detected 3.) maternal history of smoking. inadequate nutrition
Procedure: Done within 30 minutes wherein the mother is in semi-fowler’s position (w/ fetal monitor). the head is extended. With two hands. after breakfast) and count each fetal movement.) pregnancy induced hypertension (PIH). 4th Maneuver: the Examiner changes the position by facing the patient’s feet. mother activates the “mark button” on the electronic monitor when she feels fetal movement.begin after meal . less vigorous Movement alarm signals . shape.breakfast a. When the brow is on the same side as the small parts. with both hands palpate upper abdomen and fundus. Daily Fetal Movement Counting (DFMC) –begin 27 weeks Mom. diabetes b.) warning signs should be reported to healthcare provider immediately. assess the descent of the presenting part by locating the cephalic prominence or brow. external monitor is applied to document fetal activity. When the brow is on the same side as the back. Attitude – relationship of fetus to a part – or degree of flexion Full flexion – when the chin touches the chest 8. Cardiff count to 10 method – one method currently available (1) Begin at the same time each day (usually in the morning.) less then 10 movements in 12 hours(non-reactive. 2. biographical profile (BPP)
lasting at least 15 seconds in a 10 to 20 minute period as a result of FM 3.Failure to meet caloric requirements can lead to ketosis as fat and protein are used for energy. At least two accelerations of the FHR of at least 15 beats per minute.Development of essential pregnancy structures 60 mg/day or an increase of 10% above daily requirements for age group Adolescents have a higher protein requirement than mature women since adolescents must supply Protein increase should reflect . lentils. reactive result 1. fats x 9 Recommended Nutrient Requirement that increases During Pregnancy Requirements Food Source Calories 300 calories/day above the Caloric increase should reflect Essential to supply energy for prepregnancy daily requirement to . Good variability – normal irregularity of cardiac rhythm representing a balanced interaction between the parasympathetic (decreases FHR) and sympathetic (increase FHR) nervous system. biophysical profile.Maternal tissue growth including uterus and breasts . vegetables.Foods of high nutrient value such as . result indicates a healthy fetus with an intact nervous system ii. Nutrition – do nutritional assessment – daily food intake High risk moms: 1. fruits) .Fetal tissue growth . fish .Variety of foods representing foods .CHON x4. Nonreactive result 1. Pregnant teenagers – low compliance to heath regimen. and tissue growth. Stated criteria for a reactive result are not met 2. Baseline FHR between 120 and 160 beats per minute 2. Vegetarian mom – decrease CHON – needs Vit B12 – cyanocobalamin – formation of folic acid – needed for cell DNA & RBC formation. cheese.protein sparing so it can be used for level .Begin increase in second sources for the nutrients requiring . complex carbohydrates (whole . Extremes in wt – underweight. ketosis has been associated with fetal damage. . 4. milk . an indication of adequacy of calorie intake.Use weight – gain pattern as .increased metabolic rate maintain ideal body weight and protein. noted as an uneven line on the rhythm strip.No more than 30% fat amniotic fluid.Whole grains * vegetarians must take note of the amino acid content of CHON foods consumed to
. Could be indicative of a compromised fetus.Growth of fetus . . (BPP) or contraction stress test (CST) 9.Eggs.Development of structures required trimester during pregnancy for pregnancy including placenta.Lean meat.Dried beans.utilization of nutrients meet energy requirement to activity grains. 2. Requires further evaluation with another NST. over wt – candidate for HPN. DM 3. Low socio – economic status 4. (Decrease folic acid – spina bifida/open neural tube defect) How many Kcal CHO x4.Noncreative Nonstress Not Good Reactive Responsive is Real Good Interpretation of results i. Health teachings a. Nutrients Protein Essential for: . poultry. nuts .
green leafy vegetables . ice cream.60 – 120 mg/day along with copper and zinc supplementation for women who have low hemoglobin values prior to pregnancy or who have iron deficiency anemia. fish. legumes. liver. eggs .dark green leafy vegetables.70 mg/day of vitamin C which enhances iron absorption . tofu . kidney.. since diet alone is unable to meet pregnancy requirement .liver. 400 mcg/day representing an increase of more then 2 times the daily prepregnant requirement. 300mcg/day supplement for women with low folate levels or dietary deficiency 4 servings of grains/day
ensure ingestion of sufficient quantities of all amino acids
Calcium increases should reflect: .canned salmon & sardines w/ bones . margarine.Establishment of fetal iron stores for first few months of life
protein for their own growth as well as protein t meet the pregnancy requirement Calcium increases of .inadequate iron intake results in maternal effects – anemia depletion of iron stores. poultry.1600 mg/day is recommended for the adolescent. milk.dark green leafy vegetables.eggs. veal .Begin supplementation at 30mg/day in second trimester. Folate Essential for .nuts. .dairy products : milk. yogurt.formation of red blood cells and prevention of anemia .Growth and development of fetal skeleton and tooth buds . Folacin. egg yolk. peanuts
Increased requirements of pregnancy can easily be met with a balanced diet that
.DNA synthesis and cell formation. 10 mcg/day of vitamin D is required since it enhances absorption of both calcium and phosphorous 30 mg/day representing a doubling of the pregnant daily requirement . butter. red meat. nuts Increases should reflect . cheese .iron from food sources is more readily absorbed when served with foods high in vit C
Zinc Essential for * the formation of enzymes * maybe important in the prevention of congenital malformation of the fetus. decreased energy and appetite.Current research is : Demonstrating an association between adequate calcium intake and the prevention of pregnancy induce hypertension Iron Essential for .Vitamin D sources: fortified milk.Maintenance of mineralization of maternal bones and teeth . legumes.vitamin C sources: citrus fruits & juices. meats .Whole grains. may play a role in the prevention of neutral tube defects (spina bifida). . legumes .whole grains. cheese. cardiac stress especially labor and birth . whole grain cereals and breads . . broccoli or cabbage. potatoes . 15mcg/day representing an increase of 3 mg/day over prepreganant daily requirements.Formation of red blood cells and plasma proteins * Inadequate protein intake has been associated with onset of pregnancy induces hypertension (PIH) Calcium-Phosphorous Essential for . cantaloupe.Expansion of blood volume and red blood cells formation .liver.fetal effects decreased availability of oxygen thereby affecting fetal growth * iron deficiency anemia is the most common nutritional disorder of pregnancy. abruption placenta Additional Requirements Minerals
Zinc increases should reflect . strawberries.liver.whole grains. seafood Iron increases should reflect . lean beef.enriched. Folic Acid.1200 mg/day representing an increase of 50% above prepregnancy daily requirement. abortion.shell fish .Ca fortified foods such as orange juice . egg yolk . dried fruits . broccoli.
Vit stored in body.) f.Selenium Vitamins E Thiamine Riborlavin Pyridoxine ( B6) B12 Niacin
175 mcg/day 320 mg/day 65 mcg/day 10 mg/day 1. Robert Bradley – advocated active participation of husband at delivery process.) e.2 mg/day 2. sidelying or mom on top avoided 6 weeks prior to EDD avoid blowing or air during cunnilingus changes in sexual desire of mom during preg. premature rupture of membrane
3.) Done in moderation.strengthen chest muscles pelvic rocking/pelvic tilt. Bradley Method – Dr.as if hold urine. Hard to excrete. Psychophysical 1.)
2.) d. preterm labor 4.
a. incompetent cervix 3. Four extremities on floor -
Kegel Exercise – strengthen pulococcygeal muscles . Taking it not needed – fat soluble vitamins.) 3rd trimester – decreased desire Contraindication in sex: 1.) 1st tri – decrease desire – due to bodily changes b. vaginal spotting 1st trimester – threatened abortion 2nd trimester– placenta previa 2. helping them achieved a satisfying and enjoying childbirth experience.2 mg day 17 mg/day
meets the requirement for calories and includes food sources high in the other nutrients needed during pregnancy..exercise – relieves low back pain & maintain good posture * arch back – standing or kneeling.) c. release 10x or muscle contraction Abdominal Exercise – strengthens muscles of abdominal – done as if blowing candle 4.6 mg/day 2.5 mg/day 1. Squat – feet flat on floor Tailor Sitting – 1 leg in front of other leg ( Indian seat) Raise buttocks 1st before head to prevent postural hypotension – dizziness when changing position shoulder circling exercise. 2. Exercise – to strengthen muscles used during delivery process
principles of exercise 1.) 2nd trimester – increased desire due to increase estrogen that enhances lubrication c. a.Sexual Activity should be done in moderation should be done in private place mom placed in comfy pos.) b. Based on imitation of nature.
.) Must be individualized Walking – best exercise Squatting – strengthen muscles of perineum.iodine . Increase circulation to perineum.Magnesium . Childbirth Preparation: Overall goal: to prepare parents physically and psychologically while promoting wellness behavior that can be used by parents and family thus.air embolism Changes in sexual desire: a.
bimastoid 7cm smallest transverse Sutures – intermembranous spaces that allow molding.) leboyers – warm. Passenger a. soft music.) birthing chair – bed convertible to chair – semifowlers 2. Basic knowledge in Intrapartum. exhale mouth 3. etc Baseline Data: v/s esppecially BP. Husband is coach Features: 1.) theory of aging placenta – life span of placenta 42 wks.) relaxation tech 4. para.Features: 1. – 22 – 24 wks Physical Exams. Conscious relaxation 2.) progesterone theory – before labor. b.sinciput E – ethmoid O – occuputal . weight Obstetrical Data: gravida # preg. Psychosexual 1.2. b. baby gets warm bath. After delivery.) oxytocin theory – post pit gland releases oxytocin.) darkened rm 2.) birthing bed – dorsal recumbent pos 3. comfy room. IX.Pelvic Exams B.) prostaglandin theory – stimulation of arachidonic acid – prostaglandin.viable preg. address.) quiet environment 3.25cm . quiet. 5. The 4 P’s of labor 1. will always contract & expel its content) – contraction action 2. 1 Theories of the Onset of Labor 1.) closed eye & appearance of sleep 2. Fetal head – is the largest presenting part – common presenting part – ¼ of its length. labor & birth & care of newborn is an impt turning pt in woman’s life cycle . Hypothalamus produces oxytocin 3. Effleurage – gentle circular massage over abdominal to relieve pain 4. Intrapartal Notes – inside ER A. imaging – sensate focus 5. transverse diameter – 9. age. Lamaze: Dr.biparietal – largest transverse . disciple. conditioning & concentration. Ferdinand Lamaze req.) squatting – relives low back pain during labor pain 4.) uterine stretch theory ( any hallow organ stretched. Cleansing breathe – inhale nose. Different Methods of delivery: 1. Grantly Dick Read Method – fear leads to tension while tension leads to pain b.occiput T – temporal P – parietal 2 x Measurement fetal head: 1. Kitzinger method – preg. Admitting the laboring Mother: Personal Data: name.bitemporal 8 cm 2. Psychoprophylaxis – prevention of pain 1.flow with contraction than struggle with contraction c.
. At 36 wks degenerates (leading to contraction – onset labor). Bones – 6 bones S – sphenoid F – frontal . decrease progesterone will stimulate contractions & labor 5. dark.) Birth under H20 – bathtub – labor & delivery – warm water.contraction 4.
transverse – wider b.) coronal suture – connect parietal & frontal bone (crown) 3. Voluntary bearing down efforts c. Diagonal Conjugate – measure between sacral promontory and inferior margin of the symphysis pubis. Involuntary Contractions b. Power – the force acting to expel the fetus and placenta – myometrium – powers of labor a.) < 18 years old 3. Pelvis at 10 cm or more.) sagittal suture – connects 2 parietal bones ( sagitna) 2. Timing: frequency. complete flexion.5 cm hyper extension submentobragmatic-face presentation 2.close 2. 3. Characteristics: wave like d. Past Experience d. 4.) Anteroposterior diameter suboccipitobregmatic 9. ape like pelvis.5 cm.) lambdoidal suture – connects occipital & parietal bone Moldings: the overlapping of the sutures of the skull to permit passage of the head to the pelvis Fontanels: 1. posterior part shallow 3. oval shape. Obstetrical conjugate – smallest AP diameter. Measurement: 11.5 cm basis in getting true conjugate.) Posterior fontanel or lambda – triangular shape. duration. deeper most suitable (normal female pelvis) for pregnancy 2.5 cm=true conjugate) 2. 1 x 1 cm.) Underwent pelvic dislocation Pelvis 4 main pelvic types 1.12.iliac crest – flaring superior border forming prominence of hips Ischium – inferior portion . Measurement: 11. Support System
. intensity 4.) < 4’9” tall 2. Android – heart shape “male pelvis”. smallest AP occipitofrontal 12cm partial flexion occipitomental – 13. diamond shape. True conjugate/conjugate vera – measure between the anterior surface of the sacral promontory and superior margin of the symphysis pubis. Pelvis 2 hip bones – 2 innominate bones 3 Parts of 2 Innominate Bones Ileum – lateral side of hips . Ischial tuberosity – approximated with use of fist – 8 cm & above.0 cm 3.) Anterior fontanel – bregma. Passageway Mom 1. Closes – 2 – 3 months.( > 5 cm – hydrocephalus).5 cm . Platypelloid – flat AP diameter – narrow. (DC – 11. Psyche/Person – psychological stress when the mother is fighting the labor experience a. Tuberoischi Diameter – transverse diameter of the pelvic outlet. Anthropoid – oval. Cultural Interpretation b. 3 x 4 cm. wide.anterior part pointed. AP diameter wider transverse narrow 4.1. Preparation c. 12 – 18 months after birth.ischial tuberosity where we sit – landmark to get external measurement of pelvis Pubes – ant portion – symphisis pubis junction between 2 pubis 1 sacrum – post portion – sacral prominence – landmark to get internal measurement of pelvis 1 coccyx – 5 small bones compresses during vaginal delivery Important Measurements 1. Gynecoid – round.
Ripening of the Cervix – butter soft 5.setting of presenting part into pelvic inlet 2. decreased body wt – 1. Prep mom for CS Positioning – trendelenberg or knee chest position Emotional support Prepare for Cesarean Section Difference Between True Labor and False Labor False Labor True Labor Irregular contractions Contractions are regular No increase in intensity Increased intensity Pain – confined to Pain – begins lower back radiates to abdomen abdomen Pain – intensified by walking Pain – relived by walking Cervical effacement & dilatation * major sx No cervical changes of true labor. Increase epinephrine 4. Save energy. Lightening – setting of presenting part into pelvic brim .urinary freq.Pre-eminent Signs of Labor S&Sx: . Increase Activity of the Mother. 2.nesting instinct. 1. Danger signs: PROM Presenting part has not yet engaged Fetal distress Protruding cord form vagina
Nursing care: 1.5 – 3 lbs 6. Slip cord away from presenting part 3. Count pulsation of cord for FHT 4. Check FHT Premature Rupture of Membrane ( PROM) . Duration of Labor Primipara – 14 hrs & not more than 20 hrs Multipara – 8 hrs & not > 14 hrs Effacement – softening & thinning of cervix.2 weeks prior to EDD * Engagement. Braxton Hicks Contractions – painless irregular contractions 3. will be used for delivery.do IE to check for cord prolapse Contraction drop in intensity even though very painful Contraction drop in frequently Uterus tense and/or contracting between contractions Abdominal palpations Nursing Care. Rupture of Membranes – rupture of water. Use % in unit of measurement
. Administer Analgesics (Morphine) Attempt manual rotation for ROP or LOP – most common malposition Bear down with contractions Adequate hydration – prepare for CS Sedation as ordered Cesarean delivery may be required. especially if fetal distress is noted Cord Prolapse – a complication when the umbilical cord falls or is washed through the cervix into the vagina. Cover cord with sterile gauze with saline to prevent drying of cord so cord will remain slippery & prevent cord compression causing cerebral palsy.shooting pain radiating to the legs . Bloody Show – pinkish vaginal discharge – blood & leukorrhea 7.
pain all over Health Teaching : teach: sacral pressure on lower back to inhibit transmission of pain keep informed of progress controlled chest breathing Nursing Care: T – ires I – nform of progress R – estless support her breathing technique E – ncourage and praise D – iscomfort Pelvic Exams Effacement Dilation a. fetal monitor. Presentation/lie – the relationship of the long axis (spine) of the fetus to the long axis of the mother -spine of mom and spine of fetus Two types: b. apprehensive.Dilation – widening of cervix. Latent Phase: Assessment: Dilations: 0 – 3 cm mom – excited. cervical dilation and effacement. Encourage to void q 2 – 3 hrs – full bladder inhibit contractions 3. Unit used is cm. D – dry lips – oral care (ointment) dry linens B – abdominal breathing Transitional Phase: Assessment: Dilations 8 – 10 cm Frequency q 2-3 min contractions Durations 45 – 90 seconds intensity: strong Mom – mood changes with hyperesthesia
Hyperesthesia – increase sensitivity to touch. etc. Nursing Interventions in Each Stage of Labor 2 segments of the uterus 1.shorten 1st stage of labor 2. First Stage: onset of true contractions to full dilation and effacement of cervix. upper uterine . Station – landmark used: ischial spine .fundus 2.1. Breathing – chest breathing Active Phase: Assessment: Dilations 4 -8 cm Intensity: moderate Mom. Encourage walking . lower uterine – isthmus 1. can communicate Frequency: every 5 – 10 min Intensity mild Nursing Care: 1.2 station = presenting part 2 cm above ischial spine if (-) floating 0 station = level at ischial spine – engagement + 1 station = below 1 cm ischial spine +3 to +5 = crowning – occurs at 2nd stage of labor b.fears losing control of self Frequency q 3-5 min lasting for 30 – 60 seconds
Nursing Care: M – edications – have meds ready A – ssessment include: vital signs.1 station = presenting part 1cm above ischial spine if (-) floating . Longitudinal Lie ( Parallel) cephalic Vertex – complete flexion
LMP.will cause aspiration 3. if same BP.Breech -
Face Brow Poor Flexion Chin Complete Breech – thigh breast on abdomen. LSP. c.)Sims position/side lying 12 – 18 inch – ht enema tubing Check FHT after adm enema
. RADA LSA – left sacro anterior LST. LADT. RST.use sacrum . Transverse Lie (Perpendicular) or Perpendicular lie.)Prevent infection c. RSP
Chin / Mento LMA. double Kneeling
b. RSA. LADP. Shoulder presentation. breast lie on thigh Incomplete Breech – thigh rest on abdominal Frank – legs extend to head Footling – single.)NPO – GIT stops function during labor if with food. RMT.)Enema administer during labor a. Position – relationship of the fatal presenting part to specific quadrant of the mother’s pelvis. most painful ROP – squatting pos on mom ROT ROA Breech.put stet above umbilicus Shoulder/acromniodorso LADA.)To cleanse bowel b. let mom rest. decrease FHT Best time to get BP & FHT just after a contraction or midway of contractions Placental reserve – 60 sec o2 for fetus during contractions Duration of contractions shouldn’t >60 sec Notify MD Mom has headache – check BP. If BP increase .2. Variety: Occipito – LOA left occipito ant (most common and favorable position)– side of maternal pelvis LOP – left occipito posterior LOP – most common mal position. LMT.) Ok to shower 2.strength of contraction Contraction – vasoconstriction Increase BP. RMA. RMP Monitoring the Contractions and Fetal heart Tone Spread fingers lightly over fundus – to monitor contractions Parts of contractions: Increment or crescendo – beginning of contractions until it increases Acme or apex – height of contraction Decrement or decrescendo – from height of contractions until it decreases Duration – beginning of contractions to end of same contraction Interval – end of 1 contraction to beginning of next contraction Frequency – beginning of 1 contraction to beginning of next contraction Intensity . RMP. notify MD -preeclampsia Health teachings 1.
7 – 8 multi – bring to delivery room 10cm primi – bring to delivery room Lithotomy pos – put legs same time up Bulging of perineum – sure to come out Breathing – panting ( teach mom) Assist doc in doing episiotomy. Check time. widen vaginal canal. check cord if coiled.) Will facilitate complete flexion & extension. Pull shoulder down & up.) fetal thrushing – hyperactive fetus due to lack O2 2. Cavity Two Major Divisions of Pelvis 1. Descent 3.)To prevent laceration 2.to prevent laceration. (Support head & remove secretion. Ironing the perineum – to prevent laceration Modified Ritgens maneuver – place towel at perineum 1. Sudden gush of blood Types of placental delivery Shultz “shiny” – begins to separate from center to edges presenting the fetal side shiny Dunkan “dirty” – begin to separate form edges to center presenting natural side – beefy red or dirty Slowly pull cord and wind to clamp – BRANDT ANDREWS MANEUVER
. possible to reach rectum ( urethroanal fistula) Mediolateral – more bleeding & pain.) <120 & >160 2. Nursing Care: To prevent puerperal sepsis . Flexion 4. Second Stage: fetal stage. shorten 2nd stage of labor. supports uterus during pregnancy Linea Terminales diagonal imaginary line from the sacrum to the symphysis pubis that divides the false and true pelvis. identification of baby.) mecomium stain amnion fluid 3. True pelvis – below the pelvic inlet 2. Expulsion Three parts of Pelvis – 1. External rotation 7.
3. Lengthening of the cord 3. Third Stage: birth to expulsion of Placenta -placental stage placenta has 15 – 28 cotyledons
Placenta delivered from 3-10 minutes Signs of placental separation 1.< 48 hours only – vaginal pack Bolus of Ptocin can lead to hypotension. less pain easy to repair. complete dilation and effacement to birth. fast to heal. Inlet – AP diameter narrow. Mechanisms of labor 1. transverse diameter wider 2. Internal Rotation 5. Episiotomy – median – less bleeding. Engagement 2. Extension 6. slow to heal -use local or pudendal anesthesia. hard to repair. Fundus rises – becomes firm & globular “ Calkins sign” 2.Normal FHT= 120-160 Signs of fetal distress1. False pelvis – above the pelvic inlet.
intense excessive contractions resulting to ineffective pushing .
4. Monitor hpn (or give oxytocin IV) 9.) hypotonic – secondary uterine inertia. Lochia d. 1 gram=1cc e.cchymosis D – ischarges A – approximation of blood loss.nsg care: monitor contractions and FHR Precipitate Labor . Perineum – R .) Check lochia a. profuse bleeding. Count pad & saturation Fully soaked pad : 30 – 40 cc weigh pad. Check placement of fundus at level of umbilicus. give clear liquid-tea.dema E . massage uterus) 6. Fetal effect – fetal distress. extensive lacerations. Assist MD for episiorapy 11.maternal effect – exhaustion. Chills-due dehydration. Prolonged labor – normal length of labor in primi 14 – 20 hrs Multi 10 -14 hrs > 14 hrs in multi & > 20 hrs in primi . Nsg care for placenta: 4. If fundus above umbilicus. Earliest sign: tachycardia & restlessness Late sign: hypotension Outstanding Nursing dx: fluid volume deficit Post of mom – modified trendelenberg IV – fast drip due fluid volume def Signs of Hypovolemic Shock: Hypotension
.MD administer sedative valium. 5. Maternal Observations – body system stabilizes b. 2. Check bp 7.) Straight rooming in baby: 24hrs with mom. Administer methergine IM (Methylergonovine Maleate) “Ergotrate derivatives 8.) Partial rooming in: baby in morning . clear gelatin.edness E. deviation of fundus 1. hypovolemic shock if with bleeding. Flat on bed 12. Check perineum for lacerations 10. Check fundus (if relaxed. Give oxytocin. Check completeness of placenta.labor of < 3 hrs.) Empty bladder to prevent uterine atony 2. Let mom sleep to regain energy.Hurrying of placental delivery will lead to inversion of uterus. caput succedaneum or cephal hematoma .) hypertonic or primary uterine inertia . Bonding – interaction between mother and newborn – rooming in types 1. Monitor v/s q 15 for 1 hr. Blanket. 2nd hr q 30
minutes. at night nursery Complications of Labor Dystocia – difficult labor related to: Mechanical factor – due to uterine inertia – sluggishness of contraction 1. ginger ale./diazepam – muscle relaxant 2. Placement of the Fundus c. Fourth Stage: the first 1-2 hours after delivery of placenta – recovery stage.slow irregular contraction resulting to ineffective pushing.
) ineffective fundal pressure Uterine Rupture Causes: 1. premature contractions q 10 min 2.) sign of impending uterine rupture Amniotic Fluid Embolism or placental embolism – amniotic fluid or fragments of placenta enters natural circulation resulting to embolism Sx: dyspnea. drink 3 -4 glasses of water – full bladder inhibits contractions 5.) TAHBSO Physiologic retraction ring . Monitor: FHT > 180 bpm Maternal BP .beta-blocker If cervix is open – MD – steroid dextamethzone (betamethazone) to facilitate surfactant maturation preventing RDS
.) Improper use of oxytocin (IV drip) Sx: a. consult MD if symptoms persist Hosp: 1.) sudden pain b.Boundary bet upper/lower uterine segment BANDL’S pathologic ring – suprapubic depression a. dilation saved by administer Tocolytic agents.) short cord 2. MD will push uterus back inside or not hysterectomy.Yutopar Hcl) 150mg incorporated 500cc Dextrose piggyback.)Previous classical CS 2.bleeding to all portions of the body – eyes.)Large baby 3. If cervix is closed 2 – 3 cm.Tachycardia Tachypnea Cold clammy skin Inversion of the uterus – situation uterus is inside out. Factors leading to inversion of uterus 1.YUTOPAR.) hurrying of placental delivery 3.<90/60 Crackles – notify MD – pulmo edema – administer oral yutopar 30 minutes before d/c IV Tocolytic (Phil) Terbuthaline (Bricanyl or Brethine) – sustained tachycardia Antidote – propranolol or inderal . primi 14 – 20 Preterm Labor – labor after 20 – 37 weeks) ( abortion <20 weeks) Sx: 1. chest pain & frothy sputum prepare: suctioning end stage: DIC disseminated intravascular coagopathy. etc. empty bladder 4. avoid sex 3.) hypovolemic shock d.) profuse bleeding c. complete bed rest 2.halts preterm contractions. dilation 2-3 cm Home Mgt: 1. effacement of 60 – 80% 3. Trial Labor – measurement of head & pelvis falls on borderline.) 1. Mom given 6 hrs of labor Multi: 8 – 14. nose.
cold compress for immediate pain after 24 hrs. deciduas. despondence.urinary retention with overflow 4. Taking in phase – dependent phase (1st three days) mom – passive. mefenamic acid d.urine collection . Lochia-bld. Taking hold phase – dependent to independent phase (4 to 7 days). moderate amt 2. wbc.(puerperal sepsis).
. cant make decisions. X.) Insert family planting method common post partum blues/ baby blues present 4 – 5 days 50-80% moms – overwhelming feeling of depression characterized by crying. position prone 2. Urinary tract: Bladder – freq in urination after delivery.stimulate bladder 3. 2. Postpartal Period 5th stage of labor after 24hrs :Normal increase WBC up to 30.D&C after. Genital tract a. birth pain: 1.the first few minutes after delivery is the most critical period in mothers because the increased in plasma volume return to its normal state and thus adding to the workload of the heart. Cardiovascular System . Physiologic Changes a. Perineal area – painful – episiotomy site – sims pos.inability to sleep & lack of appetite. fear of bearing down 5.prone to thrombus formation . Ruba – red 1st 3 days present.1. Nsd & Cs with lochia. 1. Nursing Care: .early ambulation Principles underlying puerperium 1. can make decisions HT: 1. To return to Normal and Facilitate healing A. Uterus – return to normal 6 – 8 wks. Serosa – pink to brown 4 – 9th day.000 cumm Puerperium – covers 1st 6 wks post partum Involution – return of repro organ to its non pregnant state. Mom is active. Fundus goes down 1 finger breath/day until 10th day – no longer palpable due behind symphisis pubis 3 days after post partum: sub involuted uterus – delayed healing uterus with big clots of blood. activity is to tell child birth experiences.alternate warm & cold compress . microorganism. Alba – créme white 10 – 21 days very decreased amt dysuria .) Care of newborn 2. Hyperfibrinogenia .proper hygiene b. cold compress – to prevent bleeding 3. musty/mousy. Cervix – cervical opening b. hot sitz bath. Vaginal and Pelvic Floor c.when perineum has healed II. Provide Emotional Support – Reva Rubia Psychological Responses: a. This is critical especially to gravidocardiac mothers.a medium for bacterial growth. Colon: Constipation – due NPO.Preterm-cut cord ASAP to prevent jaundice or hyperbilirubenia. Systemic Changes 1. not compress sex. limited amt 3. – let mom cry – therapeutic.
bleeding to any part of body .
Late Postpartum hemorrhage – bleeding after 24 hrs – retained placental fragments Mgt: D&C or manual extraction of fragments & massaging of uterus. purulent discharges
.) shave 3.
Mgt: 1.sources of infection 1.
III.redefines new roles may extend until child grows.) 3.cryoprecipitate or fresh frozen plasma
II. Baggy or relaxed uterus & profuse bleeding – uterine atony.large baby .too much manipulation .) anaerobic streptococci – most common . Prevent complications
1.degree of laceration . Inflammation – calor (heat).c.pudendal anesthesia Mgt: 1.) cold compress every 30 minutes with rest period of 30 minutes for 24 hrs 2. scraping & suturing Infection. . Well contracted uterus + bleeding = laceration .)
Early postpartum hemorrhage– bleeding within 1st 24 hrs. Hemorrhage – bleeding of > 500cc
CS – 600 – 800 cc normal NSD 500 cc
I. Complications: hypovolemic shock.) incision on site. Acreta – attached placenta to myometrium.) 4. percreta.failure to coagulate.) 2.assess perineum for laceration . rubor (red). dolor (pain) tumor(swelling) 2. Hypofibrinogen. Letting go – interdependent phase – 7 days & above.) exogenous – from outside 1.mgt episiorapy DIC – Disseminated Intravascular Coagulopathy.hysterectomy if with abruption placenta mgt: BT. .) unhealthy sexual practices General signs of inflammation: 1. 2nd degree – 1st degree + muscles of vagina 3rd degree – 2nd degree + external sphincter of rectum 4th degree – 3rd degree + mucus membrane of rectum
Breast feeding – post pit gland will release oxytocin so uterus will contract. Mom . massage uterus until contracted cold compress modified trendelenberg IV fast drip/ oxytocin IV drip
1st degree laceration – affects vaginal skin & mucus membrane.from members health team 2.)endogenous – from within body 2. D&C except placenta increta. Increta – deeper attachment of placenta to myometrium Percreta – invasion of placenta to perimetrium hysterectomy
Hematoma – bluish or purple discoloration of SQ tissue of vagina or perineum.
watery. cold compress.) determine one’s own beliefs 1st 2. hydration.start 5th day of mens 28day pill. paracetamol.) method of choice is an individuals choice. Best method Social Method – 1.least effective method 2. Endometriosis – inflammation of endometrial lining Sx: Abdominal tenderness.
Gen mgt: 1. Consult OB-6mos. between & resulting. VITC.start 1st day of mens missed 1 pill – take 2 next day Physiologic MethodPills – combined oral contraceptives prevent ovulation by inhibiting the anterior pituitary gland production of FSH and LH which are essential for the maturation and rupture of a follicle.) supportive care – CBR.) never advice a permanent method of planning 3. 99.menstruation will come out 4 – 6 months bottle fed 2 – 3 months disadvantage of lam – might get pregnant Symptothermal – combination of BBT & cervical. Natural Method – the only method accepted by the Catholic Church Billings / Cervical mucus– test spinnbarkeit & ferning (estrogen) .longest – 11 June 26 .) coitus interuptus/ withdrawal .3. Fowlers – to facilitate drainage & localize infection oxytocin & antibiotic IV.9% effective.3 months.clear.shortest – 18 .monitor cycle for 1 year . coitus interfemora – “ipit” 4. breast feeding. stretchable. saline. coitus reservatus – sex without ejaculation – 3. culture & sensitivity – for antibiotic prolonged use of antibiotic lead to fungal infection inflammation of perineum – see general signs of inflammation 2 to 3 stitches dislocated with purulent discharge Mgt: Removal of sutures & drainage.-get short test & longest cycle from Jan – Dec .18 8 Dec 33 -11 22 unsafe days
21 day pill. pos.get before arising in bed LAM – lactation amenorrheal method – hormone that inhibits ovulation is prolactin. TSB. elastic – long spinnbarkeit Basal Body Temperature 13th day temp goes down before ovulation – no sex . calendar method OVULATION –count minus 14 days before next mens (14 days before next mens) Origoknause formula – . Motivate the use of Family Planning 1. Waiting time to become pregnant.
headache E – eye problems S – severe leg cramps If mom HPN – stop pills STAT! Adverse effect: breakthrough bleeding Contraindicated: 1. .) Check for string daily 2. or more days. it will shorten duration Norplant – has 6 match sticks – like capsules implanted subdermally containing progesterone.others: P eriod late (pregnancy suspected) Abnormal spotting or bleeding A bdominal pain or pain with intercourse I nfection (abnormal vaginal discharge) N ot feeling well. immediately take the forgotten tablet plus the tablet scheduled that day. if 1 kid only don’t use IUD HT: 1.Alerts on Oral Contraceptive: -in case a mother who is taking an oral contraceptive for almost long time plans to have a baby.5 yrs – disadvantage if keloid skin . . . If forgotten for two consecutive days.as soon as removed – can become pregnant Mechanism and Chemical Barriers Intrauterine Device (IUD) Action: prevents implantation – affects motility of sperm & ovum .) DM 5. .if a new oral contraceptive is prescribed the mother should continue taking the previously prescribed contraceptive and begin taking the new one on the first day of the next menses. Signs of hypertension Immediate Discontinuation A – abdominal pain C – chest pain H . use another method for the rest of the cycle and the start again.) extreme obesity 3.) chain smoker 2.prevents implantation .parity or # of children.right time to insert is after delivery or during menstruation primary indication for use of IUD . fever. she would wait for at least 3 months before attempting to conceive to provide time for the estrogen and progesterone levels to return to normal.) Regular pap smear Alerts.most common complications: excessive menstrual flow and expulsion of the device (common problem) .discontinue oral contraceptive if there is signs of severe headache as this is an indication of hypertension associated with increase incidence of CVA and subarachnoid hemorrhage. chills S trings lost.) Thrombophlebitis or problems in clotting factors
if forgotten for one day.
DMPA – depoproveda – has progesterone inhibits LH – inhibits ovulation Depomedroxy progesterone acetate – IM q 3 months .) Monthly checkup 3.) HPN 4. shorter or longer
.never massage injected site.
General Management 1. gives highest protection against STD – female condom Alerts: Disadvantage: .Uterine inflammation. infection. jellies.) 5.) CBR 2.) plasma germ defect Classifications:
a.miscarriage Cause: 1.) chromosomal alterations 2. Bilateral Tubal Ligation – can be reversed 20% chance. REVERSABLE Ht: 1. Foam (most effective).) 2. cramping.) 3.) Complete – all products of conception are expelled. During delivery. creams S/effect: Toxic shock syndrome
Alerts: Should be kept in place for about 6 – 8 hours Cervical Cap – most durable than diaphragm no need to apply spermicide C/I: abnormal pap smear Foams. Mgt: D&C Incompetent cervix – abortion McDonalds procedure – temporary circlage on cervix S/E. Jellies.) Ultrasound to determine integrity of sac 5.) Incomplete – Placental and membranes retained. Abortions – termination of pregnancy before age of viability (before 20 weeks) Spontaneous Abortion. Threatened – pregnancy is jeopardized by bleeding and cramping but the cervix is closed b.) Save discharges – for histopathology – to determine if product of conception has been expelled or not First Trimester Bleeding – abortion or eptopic A.it gives higher protection in the prevention of STDs Diaphragm – rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus. ectopic pregnancy Condom – latex inserted to erected penis or lubricated vagina Adv. HT: >30 ejaculations before safe sex O – zero sperm count. tissue protrudes form the cervix (Cervical dilation)
Types: 1. Inevitable – moderate bleeding.) blighted ovum 3. safe XI.) 4. No mgt just emotional support! 2.) Assess for bleeding (per pad 30 – 40cc) (wt – 1gm =1cc) 4.) Signs of Hypovolemic shock 6. circlage is removed. HT: avoid lifting heavy objects Vasectomy – cut vas deferense.it lessen sexual satisfaction . uterine perforation. High Risk Pregnancy 1.) proper hygiene check for holes before use must stay in place 6 – 8 hrs after sex must be refitted especially if without wt change 15 lbs spermicide – chem.) Avoid sex 3. Barrier ex. Creams Surgical Method – BTL . NSD
Hydatidiform Mole “bunch or grapes” or gestational trophoblastic disease.
C. Recurs. sharp. This neoplasm is formed form the selling of the chronic villi and lost nucleus of the fertilized egg. producing a diploid number 46 XX. Use: methotrexate to prevent choriocarcinoma Assessment: Early signs vesicles passed thru the vagina Hyperemesis gravidarium increase HCG Fundal height Vaginal bleeding( scant or profuse) Early in pregnancy High levels of HCG Preeclampsia at about 12 weeks Late signs hypertension before 20th week Vesicles look like a “ snowstorm” on sonogram Anemia Abdominal cramping Serious complications hyperthyroidism Pulmonary embolus Nursing care: Prepare D&C Do not give oxytoxic drugs Teachings: a. Habitual – 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix. Present 2nd trimester d.) Induced Abortion – therapeutic abortion to save life of mom. common site: tubal or ampular
Dangerous site . – with fertilization.missed period . The nucleus of the sperm duplicates. Progressive degeneration of chorionic villi.abdominal pain within 3 -5 weeks of missed period (maybe generalized or one sided) . dark brown.gestational anomaly of the placenta consisting of a bunch of clear vesicles. (-) preg test.scant. Missed – fetus dies.sudden . scanty dark brown bleeding Mgt: induced labor with oxytocin or vacuum extraction 5.Sheridan – permanent surgery cervix. product of conception remain in uterus 4 weeks or longer. shoulder pain (indicative of intraperitoneal bleeding that extends to diaphragm and phrenic nerve) + Cullen’s Sign – bluish tinged umbilicus – signifies intra peritoneal bleeding syncope (fainting) Mgt: Surgery depending on side Ovary: oophrectomy Uterus : hysterectomy
Second trimester bleeding C. Double effect choose between lesser evil. severe pain. signs of pregnancy cease. Unilateral radiating to shoulder.interstitial Unruptured . vaginal bleeding Nursing care: Vital signs Administer IV fluids Monitor for vaginal bleeding Monitor I & O Tubal rupture . it grows & enlarges the uterus vary rapidly. CS c. Ectopic Pregnancy – occurs when gestation is located outside the uterine cavity. Avoid pregnancy for at least one year
. . Return for pelvic exams as scheduled for one year to monitoring HCG and assess for enlarged uterus and rising titer could indicative of choriocarcinoma b.
Severe abdominal pain Dropping coagulation factor (a potential for DIC) Complications: Sudden fetal blood loss -placenta previa & vasa previa Nursing Care: Infuse IV.Third Trimester Bleeding “Placenta Anomalies”
covering the cervical os. . J. enema – may lead to sudden fetal blood loss Double set up: delivery room may be converted to OR Assessment: Engagement (usually has not occurred) Fetal distress Presentation ( usually abnormal) Surgeon – in charge of sign consent.candidate for CS Sx: frank Bright red Painless bleeding Dx: Ultrasound Avoid: sex. Placenta Previa – it occurs when the placenta is improperly implanted in the lower uterine segment. H. L. I. Abnormal lower implantation of placenta. It usually occurs after
the twentieth week of pregnancy. count pads Report s/sx of DIC Monitor v/s for shock Strict I&O Placenta succenturiata – 1 or 2 more lobes connected to the placenta by a blood vessel may lead to retained placental fragments if vessel is cut. G. RN as witness MD explain to patient complication: sudden fetal blood loss Nursing Care NPO Bed rest Prepare to induce labor if cervix is ripe Administer IV
E. Placenta Circumvalata – fetal side of placenta covered by chorion Placenta Marginata – fold side of chorion reaches just to the edge of placenta Battledore Placenta – cord inserted marginally rather then centrally Placenta Bipartita – placenta divides into 2 lobes Vilamentous Insertion of cord.cord divides into small vessels before it enters the placenta Vasa Previa – velamentous insertion of cord has implanted in cervical OS
F. Outstanding Sx: dark red. painful bleeding. Assessment: Concealed bleeding (retroplacental) Couvelaire uterus (caused by bleeding into the myometrium)-inability of uterus to contract due to hemorrhage. prepare to administer blood Type and crossmatch Monitor FHR Insert Foley Measure blood loss.
. Abruptio Placenta – it is the premature separation of the placenta form the implantation site. K. board like or rigid uterus. IE.
Three types of pre-eclampsia 1. sodium excretion. Provide safety. quiet calm environment 2. prevent – Mg So4 – CNS depressant E – valuate physical parameters for Magnesium sulfate Magnesium SO4 Toxicity: 1.) Mild preeclampsia – earliest sign of preeclampsia a.) common to mom with low socioeconomic status due to decrease intake of CHON Nursing care: P – romote bed rest to decrease O2 demand.+2 2.
I. Transissional Hypertension – HPN between 20 – 24 weeks III.HPN after 24 wks of pregnancy. epigastric pain due to liver edema and oliguria usually indicates an impending convulsion. BP decrease 2.) HELLP syndrome – hemolysis with elevated liver enzymes & low platelet count II.+4 3.tongue depressor .prepare the following at bedside . antidote – Ca gluconate 3.) idiopathic or unknown common in primi due to 1st exposure to chorionic villi 2. Cause of preeclampsia 1. water immersion will cause to urinate.) common in multiple pre (twins) increase exposure to chorionic villi 3. Pregnancy Induced Hypertension (PIH). P.) Gestational hypertension .) Severe preeclampsia Signs present: cerebral and visual disturbances. facilitate.) increase wt due to edema b.) Pre-eclampsia – HPN with edema & protenuria or albuminuria HE P/A 3. Urine output decrease 3.) dimly lit room .) Eclampsia – with seizure! Increase BUN – glomerular damage.) BP 140/90 c. protenuria +3 . Resp < 12 4.) minimal handling – planning procedure 3.hyperglycemia 3 degrees GTT of > 130 mg/dL maternal effect DM 1.absence of insufficient insulin (Islet of Langerhans of pancreas) Function: of insulin – facilitates transport of glucose to cell Dx: 1 hr 50gr glucose tolerance test GTT Normal glucose – 80 – 120 mg/dl < 80 – hypoclycemic ( euglycemia) > 120 .2. BP 160/110 .HPN without edema & protenuria H without EP 2. E – ensure high protein intake ( 1g/kg/day) . Chronic or pre-existing Hypertension –HPN before 20 weeks not solved 6 weeks post partum.) avoid jarring bed P. Patella reflex absent – 1st sigh Mg SO4 toxicity. 2nd – 3rd trim – hyperglycemic
. 1.Na – in moderation A – anti-hypertensive drug Hydralazine ( Apresoline) C – convulsion.) Hypo or hyperglycemia – 1st trimester hypo. solved 6 weeks post partum.) protenuria +1 .prevent convulsions by nursing measures or seizure precaution 1.turning to side done AFTER seizure! Observe only! for safely.Diabetes Mellitus .
to prevent sub acute bacterial endocarditis 2. marked limitation of physical activity.) 3.2.< 7mg% Sx: Calcemia tetany Trousseau sign Give calcium gluconate if decrease calcium Recommendation Therapeutic abortion If push through with pregnancy 1.) preterm birth to prevent stillbirth Newborn Effect : DM 1. 50% increase insulin at 2nd – 3rd trimester. Post partum decrease 25% due placenta out. 5. Multiple gestation
. Recommendation of class I & II 1.) 4.good progress for vaginal delivery Class III & IV. No valsalva maneuver Regional anesthesia! Low forcep delivery due to inability to push. administer dextrose 3. decrease in insulin by 33% in 1st tri. It will shorten 2nd stage of labor. Ordinary activity causes discomfort Recommendation: 1.) hypocalcemia . for vaginal delivery. Cesarean Delivery Indications: a.poor prognosis.) sleep 10 hrs a day 2.moniliasis Polyhydramnios Dystocia-difficult birth due to abnormalities in fetus or mom. Even at rest there is fatigue & discomfort.moderate limitation of physical activity.) anticoagulant – heparin doesn’t cross placenta
Class I & II. not CS! NOT lithotomy! High semi-fowlers during delivery.) early hospitalization by 7 months Class IV. Heart disease Moms with RHD at childhood Class I – no limit to physical activity Class II – slight limitation of activity.) hyper & hypoglycemia 2.) antibiotic therapy.) hyperinsulinism 2.) rest 30 minutes & after meal Class III .) Insulin requirement. Intrapartal complications 1.) macrosomia – large gestational age – baby delivered > 400g or 4kg 3.) hypoglycemia normal glucose in newborn 45 – 55 mg/dL hypoglycemic < 40 mg/dL Heel stick test – get blood at heel Sx: Hypoglycemia high pitch shrill cry tremors. Recommendation: Therapeutic abortion XII. Fetal effect 1. Ordinary activity causes fatigue & discomfort.)
Sims Huhner test – or post coital test.) .) Secondary – 1st pregnancy. Once classical always classical b. classical – vertical insertion.use of IUD . c. Low segment – bikini line type – aesthetic use VBAC – vaginal birth after CS INFERTILITY .Manageable STERILITY .need: sperm only .irreversible Impotency – inability to have an erection 2 types of infertility 1. no more next preg test male 1st .) occupation.inability to achieve pregnancy. e. j.b. h.sterile bottle container ( not plastic has chem.appendicitis (burst) & scarring = dx: hysterosalphingography – used to determine tubal patency with use of radiopaque material Mgt: IVF – invitrofertilization (test tube baby) England 1st test tube baby To shorten 2nd stage of labor! 1.truck driver 2.) Mom: anovulation – no ovulation.sperm motility for impotency Factors: low sperm count 1. Within a year of attempting it .) Tubal Occlusion – tubal blockage – Hx of PID that has scarred tubes .) primary – no pregnancy at all 2. d.) episiotomy
. antihyper prolactineuria Give mom clomid: action: to induce oogenesis or ovulation S/E: multiple pregnancy 2.
Diabetes Active herpes II Severe toxemia Placenta previa Abruptio placenta Prolapse of the cord CPD primary indication Breech presentation Transverse lie
Procedure: a.) fundal pressure 2. f. Due to increase prolactin – hyperprolactinemia Administer. g.) chain smoker administer: clomid ( chomephine citrate) to induce spermatogenesis Mgt: GIFT= Gamete Intra Fallopian Transfer for low sperm count Implant sperm in ampula 1. Procedure: sex 2 hours before test mom – remains supine 15 min after ejaculation
Normal: cervical mucus must be stretchable 8 – 10 cm with 15 – 20 sperm.more practical & less complicated . If >15 – low sperm count Best criteria. parlodel ( Bromocryptice Mesylate) Action. i.
) forcep delivery