MATERNAL AND CHILD HEALTH NURSING

Definition:
It involves care of the woman and family throughout pregnancy and childbirth and the health promotion and illness care for the children and families.

I. PHILOSOPHY OF MATERNAL AND CHILD NURSING

PHILOSOPHY OF MCN 1. 2.A challenging role for the nurse 11. 5. Family centered Community centered Research oriented Based on nursing theory Protects the rights of the family members Uses a high degree of independent functioning Places importance on health promotion Based on the belief that pregnancy or childhood illness are stressful because they are crises 9. 4. 6. A major factor in promoting high level wellness in families . 7. 8. Based on the belief that personal cultural and religious attitudes and beliefs influence the meaning of illness and its impact on the family 10. 3.

PRINCIPLES OF MCN
1. The family is the basic unit of the society. It is the structural unit of the society. 2. Families represent racial, ethnic, cultural and socio-economic diversity. 3. Children grow both individually as a part of the family.

PHASES OF HEALTH CARE IN MCN
1. Health Promotion – educating the client to be aware of healthy living through teaching and role modeling. 2. Health Restoration – promptly diagnosing and treating illness using interventions that will turn client to wellness most rapidly. 3. Health Maintenance – intervening to maintain health when risk of illness is present. 4. Health Rehabilitation - preventing further complications from an illness bringing ill client back to optimal state of wellness for helping the client accept inevitable death.

TRENDS IN MATERNAL AND CHILD HEALTH CARE
a) Families are smaller in size than in previous decades. b) Single parents are increasing in number. c) An increasing number of mothers work outside the home. d) Families are more mobile than previously. e) Abuse is a more common than ever before. f) Families are more health conscious than previously. g) Health care must respect cost containment.

II. NURSING CARE OF THE CHILD BEARING FAMILY .

REVIEW OF THE REPRODUCTIVE ANATOMY AND PHYSIOLOGY .A.

MALE REPRODUCTIVE SYSTEM .

shaft or body ii. the male organ of copulation and urination b. . b. EXTERNAL ORGANS a. keeps the sperm viable. SCROTUM – is a sack-like structure containing the testes that hang behind the penis. urethral meatus – a slit-like opening located at the tips of the penis which serves as a passageway of both sperm and urine. prepuce – a fo9ld of retractable skin covering the glans and which is removes during circumcision. glans penis – the most sensitive part iii.1. has the following parts: i. iv. PENIS a.

VAS DEFERENS – the contractile power of this part of the duct system propels the spermatozoa to the urethra during ejaculation. EPIDIDYMIS – is a long coiled tube. approximately 20 feet long at which the sperm travels for 12 – 20 days c. b. EJACULATORY DUCT – connects the seminal vesicle to the urethra . principal function of the TESTES i.2. Spermatogenesis – production of sperm. d. c. TESTES a. are oval shaped organs lying within the abdominal cavity in the early fetal life and descend to the scrotum after 34-38 weeks of gestation. male gonads (testicles) – made up of loops of 900 coiled seminiferous tubules. b. INTERNAL ORGANS a. Hormone Production ii.

size. Cowper’s gland. prostate gland. 3. 2. ACCESSORY GLANDS 1.e. – a conical body lying below the bladder which secretes an alkaline fluid. PROSTATE GLAND – main responsible in the production of semen. SEMINAL FLUID/SEMEN – are secretions from the seminal vesicle. a small gland located below the prostate that secretes an alkaline fluid which helps neutralize the acidic nature of the semen. COWPER’S / BULBOURETHRAL GLAND – pea 4. MALE FERTILITY TEST/SPERM ANALYSIS – . SEMINAL VESICLE – the pouch like organs that lie behind the bladder and in front or the rectum. 5. can be assessed by examining the semen. ejaculatory duct and spermatozoa.

sperm tends to remain only in one spot exhibiting motion only of the tail 2. d. .5 – 6 ml (average is 3. sperm move rapidly across microscopic field.Characteristics of the semen which are analyzed for fertility are: a. Grade 3 a. Grade 2 a. SPERM MORPHOLOGY – abnormal forms may be 2 headed sperms.2. VOLUME. Grade 1 a. c. abnormally shaped heads and abnormal tails. 3. SPERM MOTILITY 3 Grading System 1. SPERM COUNT – normal sperm count is 120 million sperms per ml (1 teaspoon) after 3 days abstention.5 ml) after 3 days abstention. 60 % of sperm motility which is normal. b.

FEMALE REPRODUCTIVE ORGAN .

f) URETHRAL MEATUS – located on the anterior edge of the vestibule and surrounded by the SKENE’S GLAND or the paraurethral ducts which corresponds 6to the prostate in the male. . protects the surrounding delicate tissues from trauma. which is comparable to the penis in its being sensitive. EXTERNAL ORGANS a) MONS PUBIS/MONS VENERIS – lies over the symphysis pubis covered by the skin and at puber5ty by short hairs. d) GLANS CLITORIS – small erectile structure at the anterior junction of the labia minora.1. e) VESTIBULE – narrow space seen when the labia minora are separated. form an upper fold encircling the clitoris (called the PREPUCE) and unite posteriorly (called the FOURCHETTE). b) LABIA MAJORA – two folds of skin with fat underneath. contain Bartholin’s glands c) LABIA MINORA – two thin folds of delicate tissues.

ischiocavernosus. buttocks and the thigh externally. superficial and deep transverse perineal muscles and the external sphincter of the anus.g) VAGINAL ORIFICE / INTROITUS – external opening of the vagina covered by a thin membrane (HYMEN) h) PERINEUM (vulva) – area between the mons pubis. . Perineal muscles are the bulbocavernosus. “sphincter” of the urethra.

1 inch thick. dull white sex glands near the fimbrae. 2 inches wide. and weighing 50 grams in a non-pr5egnant woman. INTERNAL ORGANS a) VAGINA – a 3-4 inches long dilatable canal located between the bladder and the rectum. organ of menstruation and implantation. fertilization takes place in its outer third or outer half. passageway for menstrual discharges. kept in place by ligaments. organ of copulation. nourishes the products of conception. . e) OVARIES – almond shaped. contains rugae. c) UTERUS – hollow pear shaped fibromuscular organ. widest part (called AMPULLA) spreads into finger like projections. 3 inches long. d) FALLOPIAN TUBES/OVIDUCT/UTERINE TUBES – 4 inches long from each side of the fundus.2. b) BARTHOLIN’S GLAND – these are located beneath the vestibule on either side of the vagina and open at the lateral border of the vagina.

OTHER STRUCTURES: Bones composing the bony pelvis: 1. 4. 3. Ilium Ischium Pubis Sacrum Coccyx . 5. 2.

Shape: heart or oval shape d) PLATYPELLOID – is characterized by the transverse diameter being greater than the anteroposterior diameter. with wide sidewalls. Shape: wedge shape or angulated c) ANTHROPOID – heart-shaped pelvic characterized by the anteroposterior diameter being greater than the transverse diameter. Shape: transversely rounded b) ANDROID – male pelvic shape. and a narrow pubic arch. prominent ischial spines.FOUR TYPES OF PELVIS a) GYNECOID – female pelvis shaped found in approximately 50 % of women. with straight pelvic sidewalls. the ischial spines are not usually prominent. Shape: flat in shape but with oval inlet. . characterized by convergent sidewalls. the anteroposterior and the transverse diameters are relatively equal.

5 cm c) TRUE CONJUGATE – conjugate vera.5 cm . 11 cm b) DIAGONAL CONJUGATE – the distance between the sacral promontory of the sacrum and the lower margin of the symphysis pubis.CONJUGATES – found in pelvic inlet a) OBSTETRIC CONJUGATE – shortest anteroposterior diameter between the sacral promontory and the symphysis pubis. it can only be measured radio graphically. 12. 11. distance between the sacral promontory of the sacrum to the upper margin of the symphysis pubis.

ROUND LIGAMENT – connective tissue that extend from the lateral uterine fundus to the upper portion of the labia majora. the uterine vessels and the uterus are contained within the base of the broad ligaments. . BROAD LIGAMENTS – extend from the lateral margin of the uterus to the pelvis. UTEROSACRAL LIGAMENT – connective tissue that extends from the inferior and posterior portion of the uterus and attach to the fascia over the sacrum. 2.OTHER RELATED STRUCTURES LIGAMENTS OF THE UTERUS 1. CARDINAL LIGAMENTS – connective tissue located at the base of the broad ligament. 4. 3. provide most of the support to the uterus.

COMPONENTS OF HUMAN SEXUALITY .B.

•THELARCHE . coitus .act of copulation.encompasses the physiologic. •ADRENARCHE . pituitary glands and gonads.•PUBERTY – encompasses the physiologic changes leading to the development of adult reproductive capacity.budding of the breast. social and cognitive changes leading to the development of adult identity. the process includes maturation of the hypothalamus.development of axillary and pubic hair •SEX . •ADOLESCENCE .

•GENDER/SEXUAL IDENTITY .the sum of the physical. •BIOLOGIC GENDER .term used to denote a person’s chromosomal sex. functional and psychological attributes that are expressed by one’s gender identity and sexual behavior. the image that a person presents to both himself/herself and others demonstrating maleness/femaleness.•SEXUALITY .the expression of a person’s gender identity.is the inner sense a person has of being male or female. •GENDER ROLE . . whether or not related to the sex organs or to procreation.

SEXUAL DEVELOPMENT (HUMAN SEXUAL CYCLE) .

pre-ejaculatory phase of life spermatozoa . PLATEAU •Formation of orgasmic platform due to prominent vasocongestion •Generalized muscle tension. increased nipple engorgement •MEN – full distension of the penis. hyperventilation.1. EXCITEMENT •vaginal lubrication and vasocongestion of the genitalia •penile erection due to vasocongestion •physical and psychological stimulus •stimulation of the penis •arterial dilation and venous constriction in the genital area 2. increase BP. tachycardia in the late plateau phase •Reached first before orgasm •WOMEN – formation of orgasmic platform.

8 seconds •Discharge of accumulated sexual tension •Shortest stage 4. ORGASM •Strong rhythmic contractions of vagina and uterus •In males.3. REFRACTORY PHASE •Only in males. RESOLUTION •Rapid decline in pelvic vasocongestion •External and internal organs return to an unaroused state •Generally takes 30 minutes 5. ejaculatory duct and prostate contract 3-4 times over a few seconds causing pooling of seminal fluid in the prostatic urethra •Rhythmic contractions in males occur at 0. the period during which no amount of stimulation can cause another erection •Not manifested in females because females are multi-orgasmic •This phase lengthens with age . seminal vesicle. vas deferens.

physical/Foreplay or Actual Psychological Stimulation .esolution R .utual C .lateau C .rousal P .onsent F . 2.oreplay A .efractory SEXUAL STIMULATION 1.rgasm R .oitus O .TANNER STAGING M .

C. MENSTRUAL CYCLE AND FAMILY PLANNING METHODS .

corpus albican (white body) .female cervical mucus .Anterior Pituitary Gland) .initiates the menstrual cycle. FSH (Follicle Stimulating Hormone) .Luteinizing Hormone (ICSH) .hormone of women .thickens the endometrium ESTROGEN .secondary sex characteristics .Gonadotropin Releasing Hormone (APG.stimulates ovulation and development of corpus luteum (yellow body).stimulates the development of the primordial follicle (immature follicle) into Graafian follicle (mature) follicles LH.HORMONES ENVOLVED GnRH .

Inhibits the production of LH ..inhibits the production of FSH .hormone of mothers .increases the fibrinogen.stimulates the development of ductile structures of the breast .increases the basal body temperature .relaxes the myometrium .prepares the endometrium . hematocrit and hemoglobin .causes hypertrophy of myometrium .stimulates uttering contraction .maintains the endometrium .increase uterine motility .maintains pregnancy .infertile mucus .transport to the fertilized ovum (zygote) into the uterus .increases the pH and the quantity of the cervical mucus PROGESTERONE .

PHASES OF THE MENSTRUAL CYCLE .

MENSTRUAL PHASE (1-5 DAYS) •Extends from the first day of menstruation to the fifth day •The first day of menses is considered the first day of the cycle •Characterized by desquamation of the superficial layers of the endometrium caused by corpus luteum regression and the consequent withdrawal of the progesterone and estrogen •About 2/3 of endometrium is shed off every menstrual period .A.

B. estrogen level is lowest on the 3rd day before ovulation •FSHRF stimulates the anterior pituitary gland to secrete follicle stimulating hormone •FSH stimulates the primordial follicle to develop into graafian follicle •As the graafian follicle develops. In a 28 day cycle. it produces large amount of estrogen. PROLIFERATIVE PHASE (6-14 DAYS) •From the 6th to day 15 of a 28 day cycle •The very low estrogen level stimulates the hypothalamus to secrete follicle stimulating hormone releasing factor (FSHRH). while at the same time an ovum is maturing inside •Estrogen promotes regeneration and proliferation of the cells of endometrium and formation of new capillaries Also called: ESTROGENIC PHASE FOLLICULAR PHASE POST-MENSTRUAL PHASE .

the lining of the uterus becomes soft. this occurs in preparation for implantation and pregnancy . it finally ruptures releasing the mature ovum •After ovulation. As a result. spongy and edematous. the graafian follicle will be called corpus luteum •The corpus luteum produce large amount of progesterone •Progesterone is said to cause “opening of the uterus: as this hormone further decreases the vascularity of endometrium and stimulates endometrial glands to secrete mucin. with follicle fluid. nutrient and glycogen.C. SECRETORY PHASE (15-23 DAYS) •From the 14th day to the 24th day or from the day of ovulation until about 3-4 days before the next menstruation •The rising pituitary gland to secrete FSH. the very low progesterone level triggers the hypothalamus to release LHRF •LHRF stimulates the anterior pituitary gland to secrete Luteinizing Hormone (LH) •LH promotes ovulation. As the graafian follicles becomes overly distended.

it regresses resulting in withdrawal of estrogen and progesterone.•The corpus luteum has an average lifespan of about 8 days. •If no fertilization occurs. the time when the corpus luteum is suppose to atrophy •The secretion of human chorionic gonadotropin (HCG) by the trophoblast cells of the zygote will prolong the life of the corpus luteum. •The corpus luteum then will continue to produce estrogen and progesterone until the third time or 12th week of pregnancy when the placenta is mature enough to take over the function of hormone production •The corpus luteum having accomplished its role after 12 weeks will now atrophy •The secretory phase is the endometrial phase that proceeds nidation or implantation Also called: PROGESTATIONAL PHASE OVULATORY PHASE LUTEAL PHASE . If no fertilization occurs at this time. the fertilized ovum or zygote implant between 7-10 days after fertilization.

D. to endometrium is cut off. thus menstruation occurs •The onset of menstruation signals the beginning of another menstrual cycle Also called: POST-OVULATORY PHASE PREMENSTRUAL PERIOD . the life of the corpus luteum is only 810 days. Blood supply. then. •Lack of blood vessels and endometrial sloughing •The desquamated cells are discharge. ISCHEMIC/PREMENSTRUAL PHASE (24-28 DAYS) •As mentioned earlier. if fertilization does not take place. the corpus luteum shrivels •Degeneration of the corpus luteum in withdrawal of estrogen and progesterone •Absence of progesterone results in arteriolar spasm and vasoconstriction.

FAMILY PLANNING METHOD .

2.A. Accepted by religions and inexpensive. Techniques including checking the body temperature or cervical mucus daily and recording menstrual cycles on a calendar to determine the days when the body is most fertile. Natural Family Planning Methods 1. Effectiveness 81% 3. .

Artificial Family Planning Methods 1. creams.B. Typical effectiveness 70% Available over the counter and can be used with other methods to improve effectiveness 2. Condoms Male condom is a sheath of latex or animal tissue placed on erect penis  Female condom is a plastic sac with a ring on each end inserted into the vagina. Both may be used with a spermicide . jellies or suppositories that are inserted into the vagina to kill the sperm before they can enter the uterus. Spermicides Chemicals in the form of foams.

. 5. Intrauterine Device small device inserted by a health care professional into the uterus and prevents eggs from being fertilized and implanting in uterus. One pill is taken daily to prevent ovaries from releasing eggs and thickens the cervical mucus to prevent sperm reaching egg. 4. Diaphragm Shallow latex cup with flexible rim inserted into vagina over cervix to prevent sperm from entering uterus with spermicide.3. Birth Control Pills Prescription drugs that contains the female hormones (estrogen).

Hormonal Injection (Depo-Provera) injection given by a health care professional in the arm or buttocks every 12 weeks to prevent ovaries from releasing an egg of thickened cervical mucus to keep sperm from reaching the egg. 7. 8. Cervical Cap Thimble-shaped latex cap inserted into a vagina over cervix to prevent sperm from entering uterus used with spermicide. . Hormonal Implant (Norplant) Six small capsules inserted by a health care professional under the skin of the upper arm that deliver small amounts of hormone to prevent ovaries from releasing eggs.6.

Permanent Methods of Reproductive Life Planning 1. 2. Vasectomy surgical procedure to permanently block the male’s vas deferens to prevent sperm from reaching eggs.C. . Tubal Ligation surgical procedure to permanently block woman’s fallopian tubes to prevent eggs from reaching by sperm.

DIFFERENT MENSTRUAL CONCERNS .

the interval between ovulation and menstruation is approximately 14 days. non-fertilized ovum.AMENORRHEA – absence of menses DYSMENORRHEA – painful. . difficult menstruation METRORRHAGIA – bleeding in between menses MENORRHAGIA – excessive bleeding during regular menstruation MENOPAUSE – cessation of menstruation OLIGOMENORRHEA – markedly diminished menstrual flow. usually occur in the middle of the menstrual cycle. nearing amenorrhea POLYMENORRHEA – frequent menstruation occurring at intervals of less than 3 weeks OVULATION – monthly growth and release of mature.

CONCEPTION AND FETAL DEVELOPMENT .D.

during which time rapid cell division (mitosis) is taking place. Implantation/ Nidation – immediately after fertilization. .Terminologies: Fertilization. the fertilized ovum or zygote stays in the fallopian tube for 3 days.union of the sperm and the mature ovum in the outer third or outer half of the fallopian Tube.

outer layer of zygote •An aggregate of cells that surrounds the zona pellucid of the ovum . •It is secreted by the ovum during its development in the ovary and is retained until nnear the time of implantation.inner layer of zygote •The thick.Zonapellucida. non-cellular membrane that encloses the mammalian ovum. Corona Radiata. transparent.

corpus luteum . Blastocyst. the inner layer (embryoblast) later forms the embryo.The outer layer (trophoblast) later forms the placenta.Morula. spherical mass od cells resulting from the cleavage of the fertilized ovum in the early stages of embryonic development .The embryonic form that follows the morula in human development .a solid. fluid filled cavity(blastocele) surrounded by two layers of cells.A spheric mass of cells having a central. .Represents an intermediate stage between the zygote and the blastocyst. .

.It is the layer of tissue that forms the wall of the blastocyst in the uterine wall and in supplying nutrients to the embryo. which forms the chorion and the syncitiotrophoblast. which developd into the outer layer of the placenta.Fingerlike projections form around the blastocyst and this trophoblast are the ones which will implant high on the anterior or posterior surface of the uterus.At implantation the cells differentiate into two layers. . .Trophoblast or Trophectoderm . the inner cytotrophoblast.

usually from the 8th week fertilization until birth. Zygote. -The period is characterized by rapid growth.the product of conception. and development of the main external features. it is implanted in the Uterus. as blastocyst.the human being in utero after the embryonic period and the beginning of the development of the major structural features. from implantation to birth. .the developing ovum from the time it is fertilized until. differentiation of the major organ systems.Terms to Denote Fetal Growth Ovum. Embryo (chick). the fertilized ovum and its enclosing membranes at all stages of intrauterine development. Fetus.female germ cell extruded from the ovary at ovulation. Conceptus.the stage of prenatal development between the time of implantation of the fertilized ovum about 2 weeks after conception until the end of the 7th or 8th week.

from 8th week up to time of birth .STAGES OF HUMAN PRENATAL DEVELOPMENT Zygote – first 12-14 days Embryo.from 15th day up to the 8th week Fetus.

DEVELOPMENT OF EMBRYONIC AND FETAL STRUCTURES .

MILESTONES OF FETAL GROWTH AND DEVELOPMENT .

First Lunar Month •Germ layers differentiate by the 2nd week •Fetal membranes appear by the 2nd week •Nervous system develops rapidly by the 3rd week •FHR begins to form as early as the 16th day of life. •Digestive and respiratory tract exist as a single tube until 3rd week of life when they start to separate .

placenta fully developed •Sex organs are formed by the 8th week •Meconium are formed in the intestines by the 5th – 8th week Third Lunar Month •Kidneys are able to function.urine is formed by the 12th week. •Buds of milk teeth form •Beginning of bone ossification.Second Lunar Month •All vital organs are formed by the 3rd week. •Fetal swallows amniotic fluid .

Fifth Lunar Month •VERNIX CASEOSA appears •Lanugo covers entire body •QUICKENING felt.Fourth Lunar Month •LANUGO appears – fine tiny hairs •Buds of permanent teeth form. •FHR maybe audible with Fetoscope •. Sixth Lunar Month •Skin markedly wrinkled •Attains proportions of full-termed baby .

Seventh Lunar Month •Alveoli begins to form (28 weeks AOG) Eight Lunar Month •FETUS is viable •LANUGO begins to disappear •Nails extend to end of fingers •Subcutaneous fat deposition begins Ninth Lunar month •LANUGO and VERNIX CASEOSA disappear •Amniotic fluid volume somewhat decreases Tenth lunar month •All characteristics of the normal newborn .

ASSESMENT OF FETAL GROWTH DEVELOPMENT .

1. Age of gestation (AOG)
A. NAGALE’S RULE
•Calculation of expected date of confinement (EDC) •Count back 3 months from the first day of the LMP then add 7days. Substitute number for month for easy computation •For example: September 0 – = 9 – 0 mo – 0 (JUNE) = 0 + 7 days – 10 = EDC – JUNE 10

B. MCDONALDS METHOD
•Determine AOG by measuring from the fundus to the symphysis pubis (in cm) then divide by 4-AOG in months •Example = Fundic height of 10cm / 4=4 months AOG= 10 weeks AOG

2. Measuring fundic Height
A. BARTHOLOMEW’S RULE
•Estimate AOG by the relative position of the uterus in the abdominal cavity •By the 3rd lunar month, the fundus is palpable slightly above the symphysis pubis •On the 5th lunar month the fundus is at the level of the umbilicus •On the 9th month, the fundus id below the xiphoid process

B. HAASE’S RULE
•Determines the length of the fetus in centimeters •During the first half of pregnancy, square the number if the month •(e.g. 1st lunar month 1x1 = 1cm) •During the second half of the pregnancy, multiply the month by 5 •(e.g. 6th lunar month: 6x5 = 30 cm)

C. JOHNSON’S RULE
•Estimates the weight of the fetus in GRAMS •FORMULA: fundic height in cm. n x k •“K” is a constant, it is always 155 •“n” is = 12(if fetus is engaged) = 11(if fetus is not yet engaged)

FOCUS OF FETAL DEVELOPMENT
1ST Trimester Period of organogenesis. 2nd Trimester Period of continued fetal growth and development, rapid increase in fetal length.

3rd Trimester Period of most rapid growth and development because of rapid deposition of subcutaneous fat

TERATOGENS .

German measles (Rubella) •The risk of maternal & fetal or congenital infection is related to the trimester of placental infection •Maternal infection during the first 8 weeks of gestation carries the highest rate of maternal & fetal infection 2. Sexually transmitted diseases Syphilis •My cross the placenta •Usually leads to spontaneous abortions •Incidence & mental abnormality Genital herpes •May cross placenta •Fetus contaminated after membranes rupture or with vaginal delivery .Maternal Risk factors: 1.

semen & vaginal fluid. blood products.Gonorrhea •The fetus is contaminated at the time of delivery •May result to postpartum infection •Pneumonia •Sepsis Human Immunodeficiency Virus (HIV) •The virus is transmitted through blood. & other bodily fluids such as urine. .

& growth deficits •Smoking causes vasoconstriction leading to low birth weight babies. •Alcohol during pregnancy may lead to fetal alcohol syndrome & can cause jitteriness. skin abscesses. barbiturates. amphetamines.3. physical abnormalities. and inflamed nasal mucosa. including over the counter medications should be taken unless prescribed by the physician •Substances commonly abused include alcohol. & heroin •Substances abuse threatens normal fetal growth & successful term completion of the pregnancy •Substance abuse places the pregnancy at risk for fetal growth retardation abruption placenta. cocaine. congenital anomalies. Substance Abuse •Many substances cross the placenta. therefore no drugs. crack. marijuana. trace marks. fatigue. & fetal bradycardia. •Physical signs of drug abuse include dilated or constricted pupils. a higher incidence of birth defects & stillbirths .

•Drinking – in moderation is not contra indicated but when excessive can cause transient respiratory depression in the newborn and fetal withdrawal syndrome. •Drugs – dangerous to fetus especially during the first trimester when the placental barrier is till incomplete and the different body organs are developing •Thalidomide – causes Amelia or phocomelia •Steroids – can cause cleft palate and even abortion •Iodine – causes enlargement of the fetal thyroid gland. •Streptomycin and Quinine – cause damage to the 8th cranial nerve •Tetracycline – cause staining and tooth enamel . besides. leading to tracheal ecompressin and dyspnea at birth •Vitamin k – causes hemolysis and hyperbilirubinemia •ASA and Phenobarbital – causes bleeding disorders. alcohol supplies only empty calories.

ADOLESCENT PREGNANCY .

) faulty family development d.) changing sexual behaviors in this age group c.) The early onset of menarche b.) lack of knowledge of reproduction & birth control .) poverty e.Factors that result in adolescent pregnancy include: a.

Lack of support systems 4. prolonge labor & infections 6. Fetal mortality 8. cephalopelvic disproportion . Emotional and behavioral difficulties 3. Increased risk of still birth 5. Poor nutritional status 2.The major concerns related t adolescent pregnancy includes: 1. anemia. Increased risk of maternal complications: such as hypertension. Low birth weight newborn infants 7.

CAPACITATION – property of the sperm cell to transform for fertilizing ovum ↓ Hyalorunidase – dissolves the corona radiate ↓ ACROSIN – sperm cell enters the ovum and nucleus 2 sex cells – fertilization .

FETAL CIRCULATION .

Fetal Circulation O2→ unbilical vein → ductusvenosus → Inferior vena cava → atrum →forameovale → atrium → ventricle → ascending Aorta → superior vena cava → RAtrum → pulmonary artery → ductusarteriosisus → aorta →hypograstie artery → placenta .

umbilical veins 4. Placenta 2.STRUCTURE 1. ductusvenosus 6. ductusarteriosus accessory vein connecting Umbilical vein into fetal Liver & IVC connection between Fetal lungs & aorta & directly into aorta FUNCTION gas exchange during fetal life carry in oxygenated Blood from fetus carry oxygenated Blood in fetus shunt blood from rhatrium supply blood to liver shunting larger portion blood away from lungs . umbilical arteries 3. foramen ovale LOCATION attached to interus two arteries in a cord one vein in cord opening in interatrial septum 5.

DA – O2 blood from PA to aorta → → → fossa ovalis ligamentumteres umbilical ligament → ligamentumvenosum → ligamentumarteriosum . Placenta 3.U – O2 blood fr. Fetus to placenta 4. FO – connects atrium L+R 2.unoxygenated blood Fr. U. DV – O2 blood from UV to IVC 5.AFTER BIRTH* 1. UA .

Medication .

OXYTOTIC MED. Description: smooth muscle stimulant promotes contraction to uterus. Uses: use to induce labor to promote milk let down A/E: contradiction: initially hypotension leading to rebound HPN ERGOT ALKALOIDS •Ergonovine (ergotrate) •Methylergovine (methergine) • -after delivery placenta Description: ↑ Forces & frequency uterine contraction Use: it prevents post partrum hemorrhage A/E: HPN / bradycardia Input: monitor BP & HR .

UTERINE RELAXANT (tocolytics) •Ritodrvine (yutopar) •Terbutaline sulfate Description: it relaxes uteine muscles Use: Tx for preferm labor A/E: maternal tachycardia Implication: monitor HR mother if ↑1306pm stop ritodrine PROSTAGLANDINS •Misoprostol (cytotec) •Dinoprostone (cervidil) Description: promotes cervical dilatation if enhances at 2nd stage of labor Applied as gel .

edema •Eclampsia. normal 4-7 mg/dl. uterine relaxant laxative effect Use: DOC for DIH (pregnancy include HPN) A/E: toxicity calcium lactate Antidote: calcium gluconate Imp.: monitor Mg level. UO. monitor BP. RR & patellar reflex •Pre elampsia.↑BP.Narcotic analgesic Use: ↓pain using labor A/E: respiratory depression Antidote: naloxone HCl / narcan Implication: monitor RR Teratogenicity cigarettes Env’tl teratogens . anasarca(generalize edema).Mg SO4 Description: CNS depressant.↑BP. convulsion MEPERIDINE HCL (Demerol) .

E. SIGNS OF PREGNANCY .

DIAGNOSIS OF PREGNANCY: Presumptive Signs – subjective evidence Probable Signs – objective evidence Positive Signs – absolute evidence .

First Trimester PRESUMPTIVE Amenorrhea Morning Sickness Urinary Frequency Enlargement of Uterus PROBABLE Chadwick’s sign Goodell’s sign Hegar’s sign Positive HCG Elevation of BBT POSITIVE Ultrasound evidence – 12 weeks by Doppler .

Second Trimester PRESUMPTIVE PROBABLE POSITIVE Fetal Heart Tone – 18-20 weeks by auscultation Fetal movements felt by the Examiner at 20 weeks Fetal outline on X-ray or Sonography Quickening ( fetal Kick ) Enlarged abdomen ↑skin pigmentation Braxton Hicks (chloasma and linea nigra Contraction ( false labor. Striae Gravidarum a painless uterine contraction) Ballotement .

F. PHYSIOLOGICAL CHANGES OF PREGNANCY .

Reproductive Tract Changes: • UTERUS Weight increase to about 1000 grams at full term Hegar’s sign – softening of uterine segment Operculum – mucus plugs in the cervix that are produced to seal out bacteria Goodell’s sign .A.softening of the cervix • VAGINA Chadwick’s sign .bluish discoloration of the vagina Leukorrhea – increase estrogen leads to ↑ vaginal discharge Alkaline vaginal pH: 2 microorganisms which thrive in alkaline environment •Trichomonas •Candida Albicans • OVARIES No changes No ovulation Placenta take over the function which supervises estrogen and progesterone .

INTEGUMENTARY CHANGES: •Linea Nigra – line running from navel to symphysis •Melasma or Chloasma – “Mask of Pregnancy” •Abdominal Wall •Striae Gravidarum – pink or reddish streaks C. BREAST CHANGES: •COLOSTRUM IS FORMED (4th Month) •Feeling of fullness and tingling sensation •↑ in size and nipples more erect •Montgomery gland become more bigger and protuberant •Areola becomes more darker and ↑ diameter •Skin surrounding areola turns dark .B.

palpitation. GI CHANGES:  Morning Sickness  Hemorrhoids  Heartburn or Pyrosis  Constipation and flatulence F. SYSTEMIC CHANGES: •Circulatory or Cardiovascular Easy fatigability and SOB Undue bleeding due to ↑ fibrinogen Slight hypertrophy of the Heart Systolic murmurs are common Epistaxis.D. RESPIRATORY CHANGES: Shortness of Breath . bipedal edema Vulva and rectal varicosities E.

MUSCULOSKELETAL CHANGES: •Lordosis – “Pride of Pregnancy” I.G. URINARY CHANGES •Urinary frequency • 1st Trimester d/t ↑ blood supply to the kidneys and uterus rising out of the pelvic cavity. •3rd Trimester d/t pressure of enlarged uterus on the bladder. . H. ENDOCRINE CHANGES •Placenta take over lactogen •Slight hypertrophy / enlargement of Parathyroid Gland to supply child calcium •Slight ↑of the thyroid gland leads to ↑ activity of adrenal cortex and ↑ production of cortisol anti-diuretic hormone leads to hyperglycemia.

G. PSYCHOLOGICAL TASKS OF PREGNANCY .

•First Trimester Accepting the Pregnancy The Fetus is unidentified concept with great future implications but without tangible evidence of reality •Second Trimester Accepting the baby Fetus is perceived as a separate entity •Third Trimester Preparing for parenthood Has personal identification with a real baby about to be born and realistic plan for future childcare responsibilities Let pregnant woman listen to the fetal heart sounds .

H. NURSING CARE DURING PREGNANCY .

which will permit to live outside the uterus. such as fetus that has reached a stage of development. dependent on level of technology . usually 20-28 weeks.Health Assessment During First Prenatal Visit: GRAVIDA – a pregnant woman Nulligravida = who has never been pregnant Primigravida = first time pregnancy Multigravida = 2 or more pregnancies Grandmultigravida = 5 or more pregnancies PARTURIENT – woman in labor PARTURITION/CONFINEMENT – process of labor and delivery VIABLE – capable of living.

PARITY – the number of pregnancies in which the fetus have reached viability. whether the fetus is born alive or its stillborn after viability is reached does not affect parity Nullipara = a woman who has not completed a pregnancy with a fetus that has reached the age of viability Primipara = a woman who has completed one pregnancy with a fetus that has reached the age of viability Multipara = a woman who has completed two or more pregnancy with a fetus to the stage of viability Grandmultipara = a woman who has completed at least four pregnancies .

OB SCORE: •G – number of pregnancies •P – number of pregnancies that reached the age of viability •T – number of babies born at term •P – number of preterm babies •A – number of abortions •L – number of children currently living •M– number of multiple pregnancies PRE-NATAL = before birth PERINATAL = 20th or 28th week of gestation through the end of the 28th day after birth POST-NATAL = after birth PREPARTUM = before delivery INTRAPARTUM = labor and delivery .

The term “antepartal” has been used by some to refer to the mother and “antenatal” or “prenatal” to refer more specifically to the fetus.THE PRENATAL CLINIC: •Consists of care and supervision given to the woman throughout pregnancy to ensure the health and wellbeing of both the mother and the baby by: Ascertaining the patient’s general physical condition at the beginning of the pregnancy. Prenatal Visits are Scheduled: Once a month up to the 6th month (28th weeks) Every two weeks from the 7th or 8th months (28-32 weeks) Once a week from the 9th month until delivery. Preparing the patient psychologically for pregnancy. labor. delivery and infant care. .

.INITIAL PRENATAL VISIT •It includes both the diagnosis or verification of pregnancy and the establishmenteof the data base for ongoing prenatal care.

A. INTERVIEW Probability of pregnancy with symptoms noted Menstrual History Menarche Duration and amount of flow LMP Obstetric History OB Scoring Estimation of AOG based on LMP Fundic Height Ultrasonography Computation of EDC Outcomes of previous pregnancies Contraceptive History Previous major illness Current health problems and all medications being used Reaction to pregnancy .

•Provide wipes for the removal of lubricant. PELVIC EXAMINATION Its purpose is to permit visual and digital examination of the internal and external genitalia and the pelvic contour. Drape her accordingly and avoid unnecessary exposure. the fetal heart sounds are heard loudest at the level of the umbilicus or above. The normal fetal heart rate is 120 – 160 bpm regular. assist the mother into sitting position and then stand. Nursing Responsibilities: •Give psychological care. •Help the mother relax during the procedure. and in ROA and ROP positions they are heard loudest in the Right Lower Quadrant. . fetal heart sounds are heard loudest midway between the umbilicus and the anterior superior iliac spine. In LOA and LOP positions they are heard loudest in the Left Lower Quadrant. In breech presentation. •Maintain woman in Lithotomy Position. •When the examination is complete.FETAL HEART TONE Cephalic presentations.

PELVIC MEASUREMENTS Done only two weeks before EDC X – ray Pelvimetry – is the most effective method of diagnosing Cephalopelvic Disproportion (CPD) URINE EXAMINATIONS Routine Analysis –to determine pyuria. Benedict’s Test – glycosuria. Pregnancy test Analysis for glucose albumin Heat and Acetic acid test – to determine albuminuria. Albumin in the urine should be reported immediately because it is a sign of toxemia. a sign of possible gestational diabetes. BLOOD STUDIES Hemoglobin and hematocrit Venereal Disease Research Lab (VDRL) or Rapid Plasma Reagin Test (RPR) Blood typing and Rhesus factor Antibody titer for Rubella Blood sugar .

but not into the pelvic wall or l lower 1/3 of the vagina. Speculum placement . Stage 3 – metastasis to the pelvic wall Stage 4 – metastasis beyond pelvic wall into the bladder and rectum.PAPANICOLAU SMEARS (CYTOLOGIC EXAMINATION) To detect abnormalities of cell growth by examining cells and secretions from the cervix and vagina and to diagnose Cervical Carcinoma/ Classification of Findings: Class 1 – absence of atypical or abnormal cells Class 2 – atypical or abnormal cytology but no evidence of malignancy Class 3 – cytology suggestive malignancy Class 4 – cytology strongly suggestive malignancy Class 5 – conclusive of malignancy CLINICAL STAGES: Reflect localization or spread of malignant and cervical changes Stage 1 – CA confined to cervix Stage 2 – CA extends beyond the cervix into the vagina.

LABORATORY TEST Pregnancy test CBC Urine exams for glucose and protein .PHYSICAL EXAMINATION Vital Signs Height and Weight Breast examination Abdominal examination Contour of uterus. if applicable Vaginal or bimanual examination for changes consistent with pregnancy Pap’s smear – done during 1st prenatal visit and 1st postpartum visit. fundal height Leopold’s Maneuver Fetal Heart Rate.

DANGER SIGNS TO BE REPORTED IMMEDIATELY: Vaginal Bleeding Swelling of the face. fingers and legs Severe continuous headache Dizziness or blurring of vision Flashes of light or dots before eyes Abdominal or chest pain Persistent vomiting Chills and fever Sudden escape of vaginal fluids .

COMMON DIAGNOSTIC PROCEDURES IN MCN .

Assessment of Lochia To detect the presence of infection and bleeding (side-lying position). •0 – 3 Poor ( needs resuscitation ) •4 – 6 Fair (needs suctioning and oxygenation ) •7 – 10 Good ( needs only admission care ) . determine genetic disorders and sex of fetus. activity and respiration. grimace. Amniocentesis Assesses fetal growth and maturity. it detects the cardiorespiratory nervous functioning. At first. 4. 2. The normal color of lochia is as follows: •Lochia Rubra (Reddish) – 1 to 3 days postpartum •Lochia Serosa (Brownish) – 4 to 10 days •Lochia Alba (Whitish) – 10 to 14 days The longest possible time for the patient to have lochial discharge can be up to 3 weeks to sixty days postpartum. and the second is used for planning nursing care. Alpha – Protein Levels Assesses presence of neural tube defects and Dawn’s Syndrome. APGAR Scoring Appearance. 3. pulse.1.

5. Chorionic Villi Sampling Determine some genetic aberrations.
6. Contraction Stress Test ( Oxytocin Challenge Test ) Indicates uteroplacental insufficiency and identifies pregnancies at risk •NEGATIVE RESULT – indicates absence of abnormal deceleration with all contractions. •POSITIVE RESULT – indicates FHR abnormal deceleration with all contractions.

7. Non – Stress Test (NST) Assess fetal activity and well being . Types: •Reactive Test – acceleration of FHR > 15 bpm lasting for 15 seconds and more. •Non – Reactive Test – acceleration of FHR < 15 bpm may indicate fetal jeopardy.
8. Coomb’s Test •Direct – used to test antibodies on patient’s erythrocytes. •Indirect – used to test antibodies on patient’s serum.

9. FHR Monitoring Assess FHR abnormalities. •Early Decelerations – indicate fetal head compression, reflects mirror image in the monitor and no treatment required. •Late Decelerations – placental insufficiency, reverse mirror image in the monitor Tx: Administer oxygen. •Variable Decelerations – cord compression, reflects V/W shape image in the monitor. Tx: Change the patient’s position to Left Lateral Recumbent Position and Administer oxygen. 10. Guthrie Capillary Blood Test Used to screen Phenylketonuria or PKU Normal level is 2mg/dl Provide the patient a high protein diet, 24 – 48 hours before the test. 11. Hysterosalpingography Determines patency of the fallopian tube and to detect pathology in the uterine cavity. 12. Laparoscopy Evaluates pelvic pain and infertility, and treats endometriosis lesions. NPO before the procedure.

13. Mammography Detects the presence of breast tumor. 14. Self – Breast Exam Best done a week after the menstruation. 15. Pelvic Ultrasound Detects abnormalities of the organs in the abdomen. The patient should ↑ Oral Fluid Intake 30 mins. – 1 hour before the test to distent the bladder to promote visualization of organs. 16. Percutaneous Umbilical Cord Blood Sampling (PUBS) Cardiocentesis or Funicentesis Removal of blood from Umbilical vein using an amniocentesis technique for analysis RhoGam is given to Rh negative women to prevent sensitization, since there is a possibility that the fetal blood could enter the maternal circulation. The fetus is monitored by NST before and after the procedure.

CONDITIONS ASSOCIATED WITH FIRST TRIMESTER BLEEDING

Spontaneous Miscarriage Spontaneous interruption of pregnancy Early Miscarriage – before week 16 of pregnancy Late Miscarriage – between week 16 – 24 TYPES: •Threatened Miscarriage •Imminent Miscarriage •Complete Miscarriage •Incomplete Miscarriage •Missed Miscarriage Early pregnancy failure: Recurrent Pregnancy Loss d/t •Defective Spermatozoa or Ova •Endocrine Factors •Deviations of the Uterus •Infection and autoimmune disorders .A.

Abdominal Pregnancy The placenta continues to grow in the fallopian tube. PREGNANCY Implantation occurs outside the uterine cavity.B. The most common site is in the Fallopian Tube. or it may escape into the pelvic cavity and implant on an organ such as intestine. spreading perhaps into the uterus for a better blood supply. . Causes: •Obstruction •PID •Smoking •Use of IUD C.

CONDITIONS ASSOCIATED WITH SECOND TRIMESTER BLEEDING .

A. B. Gestational Trophoblastic Disease/ Hydatidiform Mole Abnormal proliferation and degeneration of the trophoblastic villi. . Premature Cervical Dilatation Incompetent cervix Refers to a cervix that dilates prematurely and therefore cannot hold a fetus until term.

CONDITIONS ASSOCIATED WITH THIRD TRIMESTER BLEEDING .

Total Placenta Previa – implantation that totally obstructs the cervical os. a painless vaginal bleeding. Placenta Previa Low implantation of the placenta. Causes: •↑ Parity •Advanced maternal age •Past cs birth •Past uterine curettage •Multiple gestation .A. Marginal Implantation – the placenta edge approaches that of the cervical os. Partial Placenta Previa – implantation that occludes a portion of the cervical os. Low-lying Placenta – implantation on the lower rather than in the upper portion of the uterus.

Disseminated Intravascular Coagulation ( DIC ) An acquired disorder of blood clotting in which the fibrinogen level fails to below effective limits. Apparent Hemorrhage – partial separation Concealed Hemorrhage – complete separation C. Abruptio Placenta Detachment of placenta from the uterus and a painful vaginal bleeding. .B. The high thrombin level continues to encourage anticoagulation. It occurs when there is such a extreme bleeding and so many platelets and fibrin from the general circulation rush to the site that not enough are left in the rest of the body fur further clotting.

PROMOTION OF NUTRITIONAL HEALTH DURING PREGNANCY •Nutrition •Women who need special attention •Pregnant teenagers •Extremes in weighing scale – low pregnant weight and obese •Low income women •Successive pregnancies •Vegetarians Nutritional Assessment is based on taking a diet history first: •Food preferences or eating habits •Cultural or Religious Influences •Educational or Occupational .

Computation of Caloric Equivalents: •CHO x 4 •CHON x 4 •Fats x 9 Food Sources: •Protein Rich Foods •Vitamin A •Vitamin D •Vitamin E •Vitamin C •Vitamin B •Folic Acid •Calcium or Phosphorus •Iron .

25 lbs ( 10 – 12 kgs ) Distribution of Weight Gain during Pregnancy: •Fetus •Placenta •Amniotic Fluid •↑ Uterine weight •↑ Blood Volume •↑ Breast weight •Additional Fluid •Fat and Fluid Accumulation •TOTAL .2 lbs .7 lbs .1lb .4 .1 lb .3 lbs .Weight Gain during Pregnancy: •1st Trimester – 1.5 – 3 lbs is normal •2nd and 3rd Trimester – 10 – 11 lbs per Trimester is recommended •Total allowable weight gain during entire pregnancy – 20.1 ½ .1 ½ lb .6 lbs = 20 – 25 lbs .2 lbs .

Normal Pre-pregnancy BMI: •Underweight = under 18. absorption.5 – 24. congenital defects or even stillbirths.5 •Normal weight = 18.9 •Obese = above 30 . pre-eclampsias. low birth weight babies.9 •Overweight = 25 – 29.MALNUTRITION •Results in prematurity.

COMMON DISCOMFORTS IN PREGNANCY: .

and pyrosis Fatigue Muscle cramps Hypotension Varicosities Hemorrhoids Palpitations Frequent urination Abdominal discomfort Leukorrhea Second and Third Trimester Backache Headache Dyspnea Ankle edema Braxton Hicks Contraction . vomiting.First Trimester Breast Tenderness Palmar Erythema Constipation Nausea.

HEALTH PROMOTION DURING PREGNANCY .

Self-care needs: •Dental care •Perineal care •sexual activity •Exercise such as Kaegel’s Exercise •Taylor Sitting .

.Preparations for Childbirth and Parenting: “ Gate Control of Pain” Premises: -Discomforts during labor can be minimized if the woman comes into labor informed about what is happening and prepared with breathing exercises to use during labor.Discomforts during labor can be minimized if the woman’s abdomen is relaxed and the uterus is allowed to rise freely against the abdominal wall during contractions. .

Major approaches to Prepared Childbirth Grantly – Dick Read Method . full concentration on breathing exercises during labor should be observed. mouthing silently words or songs with rhythmical tapping of fingers. .Breathing techniques Lamaze •Psychoprophylactic Childbirth •Based on stimulus response conditioning. To be effective.Fear leads to tension and tension leads to pain . Leboyer Method •the contrast of uterine environment and the external world causes infant to suffer psychological shock at the time of delivery •relaxing the craniosacral axis.

I. LABOR AND DELIVERY .

Theory of Aging Placenta – because of the decrease in blood supply. being the hormone designed to promote pregnancy. Prostaglandin Theory – initiation of labor is said to result from the release of arachidonic acid produced by steroid action on lipid precursors.Theories of Labor Onset Uterine Stretch Theory – any hollow body organ when stretched to capacity will necessarily contract and empty. . Oxytocin causes contraction of the smooth muscles of the body. being considered a stressful event stimulates the hypophysis to produce oxytocin from the posterior pituitary gland. the uterus contracts. Arachidonic acid is said to increase prostaglandin synthesis. if its amount decreases labor pain occurs. which in turn causes uterine contractions. is believed to inhibit uterine motility. Progesterone Deprivation Theory – progesterone. Oxytocin Theory – labor. Thus.

SIGNS OF LABOR .

Loss of weight 5. . 2. Increase activity level 4. the cervix becomes “butter. Show – due to pressure of the descending presenting part of the fetus which causes rupture of minute capillaries in the mucus membrane of the cervix. relief of abdominal tightness and diaphragmatic pressure. Engagement – occurs when the presenting part has descended into the pelvic inlet. It is only Pinkish Vaginal Discharge. Braxton Hicks Contraction – painless. 8. Rupture of the Membranes – BOW ruptured. 3. Lightening – refers to the settling of the fetal head into the pelvic brim. 7. It results in increase in urinary frequency. shooting pains down the legs because of pressure on the sciatic nerve. Ripening of the Cervix – from Goodell’s sign. irregular practice contractions.soft”. 6.Preliminary Signs/ Prodromal Signs of Labor 1. integrity of the uterus is already destroyed.

also known as DECRESCENDO. also known as CRESCENDO. productive uterine contractions Phases: •INCREMENT – first phase which the intensity of contraction increase. . also known as APEX •DECREMENT – last phase during which intensity of contraction decreases. •ACME – the height of the uterine contraction.Uterine Contractions  The surest sign that labor has begun is the initiation of effective.

frequently and intensity 4. (thinning of the cervical) Effacement •Shortening and thinning of the cervical canal as district from the uterus. Accompanied by cervical effacement and dilatation. 3. Absent cervical changes True Labors 1.(circle movement) 3. (3-4 contraction every 2hours) 2.Differences between False and True Labor Pains False Labor Pains 1. 5. frequency and intensity. 5. 2. Remain irregular of uterine contraction. No increase in duration. Dilatation •Enlargement of the external cervical os up to 10cm primarily as a result of uterine contractions and secondarily as a result of pressure of the presenting part and the BOW. Increase in duration. First felt in the lower back and sweep around to the abdomen in a girdle-like fashion. Continue no matter what the woman’s level of activity is being done. . Maybe slightly irregular at first but become regular and predictable in a matter of hours. Often disappears if the woman ambulates/walking. 4. Generally confined to the abdomen.

20 30 minutes Multis Third Stage TOTAL 10 minutes 14 minutes 10 minutes 8 hours .Length of Normal Labor Stage of Labor First Stage Second Stage 12 ½ hours 80 minutes Primis 7 hours.

COMPONENTS OF LABOR Passage Passenger Power .

STAGES OF LABOR .

•Active/ Accelerated •Cervical Dilatation reaches 4-8cm. frequency and intensity of constractions. First Stage (Stage of Dilatation) begins with true labor pains and ends with complete dilatation of the cervix. •Transition Period •When the mood of the women suddenly changes and the nature of the contractions intensify. Rapid increase n duration. . Contractions are of short duration and occur regularly 5-10 minutes apart. Power/ Forces: involuntary uterine contractions 3 PHASES (LAT) •Latent – early in time labor •Cervix dilates only 3-4cm.A.

then AP to AP. •Expulsion – delivery of the rest of the body. •Internal Rotation – from AP to transverse. The head extends and the forehead. the back of the neck stops beneath the pubic arch. Mechanisms of Labor/ Fetal Position Changes (ED FIRE ERE) •Engagement •Descent – maybe preceded by engagement. Second Stage (Stage of Expulsion) Begins with complete dilatation of the cervix and ends with the delivery of the baby. •Extension – as head comes out. •External Rotation (also called as the Restitution) – anterior shoulder rotates externally to the AP position. •Flexion – as descent occurs. pressure from the pelvic floor causes the chin to bend forward onto the chest. mouth and chin appear. .B. nose. Power/ Forces: Involuntary uterine contractions and contraction of the diaphragmatic and abdominal muscles.

•Types of Placental Delivery Schultz – if placenta separates first at its center and last at its edges. beefy and dirty (DIRTY for DUNCAN). it slides along the uterine surface and presents with the maternal surface. Third Stage (Placental Stage) begins with the delivery of the baby and ends with the delivery of the placenta.•C. •Signs of Placental Separation •Calkin’s Sign – the earliest sign of placental separation. which is raw. . Only about 20% placentas separate this way. it tends to fold on itself like an umbrella and presents the fetal surface which is shiny (SHINY for SCHULTZ). •Sudden gush of blood from the vagina. red. Duncan – if placenta separates first at its edges. •Lengthening of the cord. 80% of placentas separate in this manner.

FOURTH STAGE •First 1 – 2 hours after delivery. which is said to be the most critical stage for the mother because of unstable VS.D.(Blood Pressure) .

•Station +3 or +4 – synonymous to crowning encircling of the largest diameter of the fetal head by the vulvar ring. synonymous to engagement •Station -1 – presenting part above the level of the ischial spines. •Station +1 – presenting part below the level of the ischial spines.First Stage •Station – relationship of the fetal presenting part to the level of the ischial spines •Station 0 – at the level of the ischial spines. .

feet are presenting. Also known as LIE 1. •In poor flexion – face. . VERTICAL •Cephalic – head is the presenting part •Vertex – head is sharply flexed. •Frank – thighs are flexed and legs are extended. brow. resting on the anterior surface of the body. making the parietal bones the presenting parts. Double – legs unflexed and extended. •Complete – thighs are flexed on the abdomen and legs are on the thighs. one foot presenting.PRESENTATION •Relationship of the long axis of the mother to the long axis of the fetus. Footling Single – one leg unflexed and extended. chin (MENTUM) •Breech – buttocks are the presenting parts.

2. HORIZONTAL •Transverse Lie •Shoulder Presentation .

POSITION •Relationship of the fetal presenting part to a specific quadrant in the mother’s pelvis. .

Possible Fetal Positions .

Vertex LOA – left oxipitoanterior – most favorable LOP – left oxipitoposterior LOT – left oxipitotransverse ROA – right oxipitoanterior ROP – right oxipitoposterior ROT – right oxipitotransverse BREECH LSA – left sacroanterior RSA – right sacroanterior LSP – left sacroposterior RSP – right sacroposterior LST – left sacrotransverse RST – right sacrotransverse FACE LMA – left mentoanterior LMP – left mentoposterior LMT – left mentotransverse RMA – right mentoanterior RMP – right mentoposterior RMT – right mentotransverse SHOULDER LADA – left acromiodorsoanterior LADP – left acromiodorsoposterior RADA – right acromiodorsoanterior RADP – right acromiodorsoposterior .

Enema Encourage the mother to void every 2 – 3 hours by offering the bedpan. . Emotional support is provided for the women in labor.NURSING CARE DURING LABOR Monitoring and evaluating important aspects like uterine contraction (duration. BP. Encourage Sim’s Position. Health Teachings – Bath. Perineal prep done aseptically and perineal shave. Assist in administration of original anesthesia. interval. frequency and intensity). Ambulation. FHT. NPO. Woman in labor should not be allowed to push or bear down unnecessarily during contractions of the first stage. Abdominal Breathing Administer analgesics as ordered.

but to pant (rapid and shallow breathing to prevent rapid expulsion of the baby). instruct mother not to push. •As soon as the fetal head crowns. put them up at the same time to prevent injury to the uterine ligaments. •Controlled chest breathing during contractions. •Sacral Pressure relieves discomfort from contractions. •Proper bearing techniques. Second Stage •When positioning legs on lithotomy. •Emotional support. •Assist in episiotomy (incision made in the perineum primarily to prevent lacerations). .Transition Period •Nursing Actions are primarily comfort measures.

Wrap the baby in a sterile towel to keep him warm. inform her of the sex and time of delivery then give the baby to the circulating nurse. Put the baby on the mother’s abdomen. Cutting the cord is postponed until the pulsations have stopped because it is believed that 50 – 100ml. Show the baby to the mother. an inch apart and then cut in between. . the newborn should be held below the level of the mother’s vulva for a few minutes to encourage flow of blood from the placenta to the baby. clamp it twice. After cord pulsations have stopped. •Mediolateral – begun in the midline but directed laterally away from the anus. Chilling increases the body’s need for oxygen. Natural Anesthesia Apply the Modified Ritgen’s Maneuver Immediately after delivery. •Often done because it prevents 4th degree laceration should it occur despite episiotomy. The infant is held with his head in a dependent position to allow for drainage of secretions. The weight of the baby will help contract the uterus.Types of Episiotomy •Median – from middle portion of the lower vaginal border directed toward the anus. of blood is flowing from the placenta to the baby at this time.

slowly rotating it so that no membranes are left inside the uterus. thus preventing hemorrhage. INTERVENTION: Provide addition blankets to keep her warm. any placental fragment retained can also cause severe bleeding and possible death. Allow patient to sleep in order o regain lost energy. May give initial nourishment. The newly delivered mother may suddenly complain of chills due to decreased BP. NOTE: OXYTOCIN are not given before placental delivery. Inject oxytocin (Methergin=0. Palpate the uterus to determine degree of contraction. fatigue or cold temperature in the delivery room. Inspect for completeness of cotyledons. Tract the cord slowly. Take note of the time of placental delivery.Third Stage Do not hurry the expulsion of the placenta by forcefully pulling out the cord or doing vigorous fundal push as this can cause uterine inversion. Make mother comfortable by perineal care and applying clean sanitary napkin snugly to prevent its moving forward from the anus to the vaginal opening. Position the newly delivered mother flat on bed without pillows to prevent dizziness due to decrease in intra abdominal pressure. winding it around the clamp until the placenta spontaneously comes out. a method called BRANDT – ANDREWS MANEUVER. Inspect the perineum for lacerations. .2mg/ ml or Syntocinon=10U/ ml) IM to maintain uterine contractions. NSG.

androgen preparations given within the first hours postpartum to prevent breast milk production on mothers who will not breastfeed. •Lactation . bladder. perineum.suppressing agents. BP and PR.Fourth Stage •Assessment of the fundus. •Rooming – In Concept (Giving the baby to the mother) •Lochia Assessment . lochia. estrogen.

PUERPERIUM .J.

she gives up the fantasized image of her child and accepts the real one. b) Involution – return of the reproductive organs to their pregnant state.Terminologies: Puerperium/ Postpartum a) Refers to the 6 week after delivery of the baby. b) Taking Hold Phase • “Woman initiates action” c) Letting Go Phase • “The woman finally redefines her new role”. labor and birth. She gives up her old role of being childless . PHASES OF PUERPERIUM a) Taking in phase (2 – 3 days) • “Woman is largely passive” • Is a time reflection • A time when the new parent review their pregnancy.

.MATERNAL NEWBORN ATTACHMENT Bonding – breast feeding Mother – “claiming” En face position Father – “engrossment” Rooming – In Sibling visitation A chance to visit the hospital and see the new baby and their mother. reduces feeling that their mother cares more about the new baby. It helps relieve from impact of separation.

MATERNAL CONCERNS AND FEELINGS IN THE POSTPARTAL PERIOD Abandonment Disappointment Postpartum blues Labile mood and affect Crying spells Sadness Insomnia Anxiety .

Reproductive System Changes . Systemic changes 2.PHYSIOLOGIC CHANGES DURING PUERPERIUM 1.

Vascular Changes 30%-50% increase in cardiac volume for 5-10 minutes after placental delivery Activation of the clotting factors.a. which encourages THROMBOEMBOLIZATION *massage is not advisable .

lower amount than in lochia rubra c) Lochia Alba. •It should approximate menstrual flow. residues.measure the fundus using fingerbreath Knee-chest position Afterpains/ afterbirth pain. •It should not have any offensive odor. etc. •It should not contain large clots.not advisable Lochia.10-14 days or up to 6 weeks. bacteria. mucous -Increase activity= increase lochia .abdominal pain for large baby.b. Genital Changes Uterine involution. moderate amount b) Lochia Serosa. minimal amount Characteristics of Lochia: •Pattern should not reverse. •Pain in the perineal region may be relieved by Sim’s position. •For breastfeeding mothers.red.4-6 days. . it last for not more than 3 days •Heat packs. •It should never be absent regardless of method of delivey.blood.breastfeeding= decrease lochia •Pattern of Lochia a) Lochia Rubra. twin delivery. 1-3 days.

Vital Signs Temperature may be increased Bradychardia is common for 6-8 days There’s no change in the respiratory rate. GI Changes Decreased muscle tone Lack of food + enema during labor Dehydration Fear of pain from perineal tenderness e. Urinary Changes Marked dieresis within 12 hours postpartum Frequent urination.c. .small amount/ scanty d/t urinary retention overflow d.

NURSING CARE DURING THE PUERPERIUM •Promote healing and return to normal (involution) of different parts of the body •Provide emotional support •Prevent postpartum complication .

Hysterectomy •Hypofibrinogenemia.POSTPARTUM COMPLICATION: 1. Ice compress (abdominal area) 3. CS 2. hypofibrinogenemia •Uterine Atony. Empty the bladder 5.blood loss of more than 500 cc during delivery *normal: 250-350 cc a. Over distention of the uterus 3. PP Hemorrhage. Placental accidents 4. laceration. Bimanual compression 6.early. Oxytocin administration 4.d/o of clotting factors *administer BT .boggy/relaxed uterine CAUSES: 1. Massage the fundus (milking massage) 2. Prolonged/difficult labor NURSING ACTIONS: 1.1st 24 hours •Causes: uterine atony.

2. PP Infection Establish successful lactation .

K. IMMEDIATE CARE OF THE NEWBORN .

cover nostril one at a time Positioning.4˚C 37. side lying but avoid prone position (promotes drainage.mouth first before nose to prevent vagal stimulation that leads to bradychrdia Establish and Maintain Patency of Airway.slight trendelenburg. high shrill cry •Spontaneous vomiting •Bregma and Lambda are bulging and very dense •Increased BP •Decreased CR & RR •Widening of pulse pressure Maintain Appropriate Temperature.Suctioning.prevents increase ICP.normal temp is 36. prevents aspiration) *Signs of Increased ICP: •High pitch.2˚C *Temperature is unstable but stabilizes in 6-8 hours .5-10 seconds to prevent hypoxia . promotes closure of foramen ovale and ductus arteriosus.

SECOND PERIOD OF REACTIVITY •Immature hypothalamus •Inadequate brown fat •Shivering mechanism is underdeveloped *Babies are born wet (more heat loss) Evaporation Radiation Convection Conduction Nursing Care: Dry once Wrap Expose to drop light Encourage the mother to cuddle and embrace the baby Complications: •Hypoglycemia.d/t use of glucose •Metabolic acidosis .

responsible for jaundice . Prevents physiologic jaundiceICTERUS NEONATORUM d/t stimulation of gastrocolic reflex *bilirubin. low levels of CHO and COOH ii. Colostrum. Breastfeeding. high antibody-IgA.best method Other Purpose: i.first milk .high levels of vitamins ABCDE.high protein-LACTOGLOBULIN.these protect infant against bacterial and viral infections of the respiratory and GI systems . Promotes uterine contraction iii.FIRST PERIOD OF REACTIVITY •Methods: 1. high WBC. macrophages and Lactoferin .

least developed but one of the best methods to promote bonding .infant remains in the woman’s room for most of the time (8AM-9PM) but he/she is taken to a small nursery near the woman’s room for the night 3. Senses stimulation: Touch and hearing.mother and child are together 24 hour a day Partial.highly developed Sight and smell.a) b) a) b) Rooming-in: Complete.

Determine the degree of acidosis and the need for CPR To evaluate ability of the NB to adjust extrauterinely and the prognosis Score Interpretation •0-3: poor.ASSESSMENT: •APGAR Scoring Test by Virginia Apgar Assess general condition of infant Done twice at 1 & 5 mins. guarded or moderately depressed. needs further observation and suctioning •7-10: good of healthy **therefore: the higher the Apgar score. the better . serious or severely depressed. needs immediate CPR •4-6: fair.

IDENTIFICATION •Best accomplished before transfer to the nursery ( footprints. birthmarks ) . ID bands.

prevent the destruction of the acid mantle of the skin Oil. STD. Gonorrhea .best done with temperature of the NB stable or at least 37˚C Water with non-alkaline soap. Candidiasis.per rectum to determine anal patency (primary reason) •Complications related to frequent rectal temperature taking: • Perforation of the mucous membrane • Vagal stimulation •Special initial care: a.CARE OF THE NEWBORN IN THE NURSERY •Recheck ID •Take the temperature initially.appropriate in case vernix caseosa is plenty Anti-microbial solution.most preferred in NB of mothers with infections in the vaginal canal: Trichomoniasis. Initial bath.

prevents Omphalitis Inspect the blood vessels (2 arteries and 1 vein).b.Betadine (prevents Tetanus Neonatorum •Alcohol 70%. in case 1 of the arteries is absent indicates a congenital disorder of possibly the GIT.Ophthalmic Ointment -Prevent or prophylactic treatment against OPHTHALMIA NEONATORUM . CV % GUT **Cord falls on 7th-10th day c. Cord dressing Done with strict aseptic technique practices Include application of CORD CLAMP.prevent OMPHALANGIA (bleeding) Include application of ANTISEPTIC SOLUTIONS: •Povidone Iodine. Credes Prophylaxis.

Konakion Full term.1 mg Preterm.1 ml Route.IM Site.Aquamephyton PHYTOMENADIONE. K injection.left vastus lateralis.Vastus Lateralis (prevent injury to sciatic nerve that may lead to paralysis .0.5 mg Amt.most common Erythromycin.Chlamydia infections.0. prevent bleeding PHYTONADIONE. 4 days Vit.05-0.MEDICATIONS: •Ophthalmic drops.Silver Nitrate 1% •Ophthalmic ointment Teramycin.

5 kg to 3.4 kg or 5.take the RECUMBENT HEIGHT in supine Children over 24 mos.normally 2.5 to 53.Macrocephaly No fetal skull.8 lbs Birth length.ANTHROPOMETRIC MEASUREMENTS: Birth weight.29-31 cm or 11-12 inches .Anencephaly Chest circumference.take height in standing position Head circumference.normally 47.5 lbs to 7.Microcephaly HC > 37 cm.75 cm Like the BW the BL: Increases by 50% at age of 1 year Doubles at 2 years (length at 2 years is half of adult height) Average of 50 cm at birth ***Note: children under 24 mos.33-35 cm or 13-14 inches HC < 32 cm.31-33 cm or 12-13 inches Abdominal circumference.

PR/CR & RR *RR: 30-60/min.common site for children over 3 y/o . irregular with normal physiologic apnea of less than 15 seconds Note: observe signs and symptoms of respiratory distress •Tachypnea •Bradypnea •Nasal flaring •Retractions •Expiratory grunt *PR: 120-160/min.180/min Characteristics: Rapid. at birth.site to check pulsation in case CPR is necessary •Femoral pulse •Pedal pulse •Radial pulse. 80/min at birth > rapid.PHYSICAL ASSESSMENT •Vital signs. irregular Increases with activity & as low as 100/min when asleep SITES: •Apical pulse.most preferred for children under 3 y/o •Brachial pulse.

2˚C Characteristics: Unstable Stabilize between 6-8 hours known as the 2nd period of reactivity *Blood Pressure: at birth.*Temperature: at birth 36.normally 60 mmHg . at 10th day 100/50 mmHg Methods: •Doppler •Flush.37.80/46 mmHg.4.

closes between 6 weeks.largest part of the body & ¼ of the total length. center of the 3 sutures.dehydration c) Craniostenosis or Craniosynostosis Complications: •Increase ICP •Mental Retardation .increased ICP b) Depressed.12 weeks or 3-4 months.18 mos. b) Posterior. 3-4 cm long and 2-3 cm wide.Head. Assess the following: Fontanels (soft spot): normally 6 in number 2-paired: Anterolateral & Posterolateral 2 single: Anterior (Bregma) & Posterior (Lambdoid) a) Anterior.triangular shaped. diamond shaped. measures 1x1 cm Assess further for: a) Bulging.closes between 12 mos. *if >5cm: sign of Cretinism/ Congenital Hypothyroidism.

Other Structures: Caput Succedaneum Affects both hemisphere Swelling of the sculp Disappears on or before 3rd day Cephalhematoma Collection of blood Caused by increase pressure of birth Rupture of periosteal capillaries Disappears in 3-4 weeks Craniotabes  Localized softening of cranial bones  Caused by early lightening (2wks for primis and 1 day for multis)  Disappears in 6 wks Eyes.NB usually cry tearlessly. . because their lacrimal ducts do not fully mature until about 3 months of age.

BREASTFEEDING .L.

causes contraction of smooth muscles of collecting tubules.hindmilk is produced.Physiology of Breastmilk Production •Estrogen and progesterone levels after placental delivery.stimulates APG to produce PROLACTINacts on acinar cells to produce foremilk.stored in collecting tubules.PPG is stimulated to produce OXYTOCIN.milk ejected forward. •When infant sucks. LETDOWN /MILK EJECTION REFLEX. .

never use plastic lining.Patient teaching: Line bra with soft cotton. not pulling the breast to the infant Teach mother to support the infant’s head while feeding such as the cradle or the football hold. upright. Well balanced diet It takes about two days for the infant to establish a sucking pattern. rinse completely Use well fitting supportive bra Avoid using harsh cleanser Use a breast pump A tingling sensation is often felt just before leakage begins. across lap. if soap is used. Milk appears 48-96 hours after delivery. Colostrums will be secreted initially and the infant should be encouraged to take it. . Let nipples air dry 5-15 mins before replacing bra Wash breasts with water. Teach positions for burping the baby. or on shoulder Fluid intake of at least 3000 ml/day Teach the mother to bring the infant to breast.

feeling of tension on the breasts during the 3rd postpartum day sometimes accompanied by fever. A. effective •Nutrition: Less than body requirements. •Sore nipples Associated problems: •Mastitis.localized pain. ineffective •Infant feeding pattern. Ca. swelling and redness. lamps in the breast and milk becomes scanty. altered Associated Problems •Engorgement. •Nutrition Lactating mothers should take 3000 calories daily and should have larger amounts of CHON (96 g/day). B & C. Fe. Vit. .Associated Nursing Diagnosis •Anxiety •Breastfeeding. ineffective •Knowledge deficit •Breastfeeding.

no mixing req’ts •Nutritionally optimal •Gastroenteritis greatly reduced Additional notes: •Ambulation a) 4-8 hours after NSD b) 24 hours after CS •Return of sexual activity: 3rd-4th week postpartum •Menstruation returns: 8th week .BREASTFEEDING •Best for babies •Reduces the incidence of allergies •Economical •Antibodies. greater immunity •Stool inoffensive •Temperature is always ideal •Fresh milk never goes off •Emotional bonding •Easy once established •Digested easily with 2-3 hours •Immediately available.

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