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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. 1. 2. 3. 4. 5. 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. 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 y 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
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Testes ± 900 coiled (½ meter long at age 13 onwards) (Seminiferous tubules)
Epididymis ± 6 meters coiled tubules site for maturation of sperm
Vas Deferens ± conduit for spermatozoa or pathway of sperm
Ant Pit Gland
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 Urethra
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
III. increase permeability of kidney to lactose & dextrose causing (+) sugar 5. 1 tsp 4. Functions of Estrogen and Progestin * Estrogen ³Hormone of the Woman´ ± Primary function: development secondary sexual characteristic female. Menses = 1st to the 5th day . hypertrophy of myometrium 3. increase BBT 10.inhibit motility of GIT 3. inhibit production of FSH ( maturation of ovum) 2. Others: 1. development ductile structure of breast 5. Basic Knowledge on Genetics and Obstetrics 1.3 ± 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. MenstruationMenstrual Cycle ± beginning of mens to beginning of next mens Average Menstrual Cycle ± 28 days Average Menstrual Period . increase sexual desire *Progestin ³ 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. Ischemic = 27 to 28th day 4. mammary gland development 4. Secretory = 15 to 26th day 3. Normal amount of ejaculated sperm 3 ± 5 cc. 2-3 days 6. Chromosomes ± threadlike strands composed of hereditary material ± DNA 3. increase osteoblast activities of long bones 6. Spinnbarkeit & Ferning ( billings method/ cervical) 4. causes early closure of epiphysis of long bones 8. Sperm is viable within 48 ± 72 hrs. Proliferative = 6 to 14th day 2.inhibit prod of LH (hormone for ovulation) 2.maturation of ovum Gematogenesis ± formation of 2 haploid into diploid 23 + 23 = 46 or diploid 7. Age of Reproductivity ± 15 ± 44yo 8. Reproductive cells divides by the process of meiosis (haploid) Spermatogenesis ± maturation of sperm Oogenesis ± process . Phases of Menstrual Cycle: 1.. increase in height in female 7. causes mood swings in moms 6. DNA ± carries genetic code 2. Ovum is capable of being fertilized with in 24 ± 36 hrs after ovulation 5. Menstrual Cycle 4 phases of Menstrual Cycle 1. causes sodium retention 9.
small head. corpus luteum degenerate ( whitish ± corpus albicans) X. On the initial 3rd phase of menstruation . (13th day-decreased progesterone) LH stimulates ovaries to release progesterone 2. estrogen level is peak while the progesterone level is down. mood swing GnRF/LHRF stimulates the ant pit gland to release LH. PhaseIncreased progesterone IX. this level stimulates the hypothalamus to release GnRH or FSHRF II.) Mittelschmerz ± slight abdominal pain on L or RQ of abdomen. Proliferative Phase ± proliferation of tissue or follicular phase.) III. long tail. Capacitation.) Change in BBT. Stimulate ovaries to release estrogen 2. uterus Initial phase ± 3rd day ± decreased estrogen 13th day ± peak estrogen. 28th day ± if no sperm in ovum ± endometrium begins to slough off to begin mens Cornix.Parts of body responsible for mens: 1. anterior pituitary gland ± master clock of body 3. 13th day of menstruation. 24th day if no fertilization. after ovulation day. 11.where sperm is deposited Sperm. Facilitate growth primary follicle to become graffian follicle (secrets large amt estrogen & contains mature ovum. these stimulates the hypothalamus to release GnRF on LHRF 1. ovaries 4. post mens phase. Pre-ovularoty. graafian follicle starts to degenerate yellowish known as corpus luteum (secrets large amount of progesterone) VIII. Secretory phaseLutheal Phase Postovulatory Premenstrual Phase V. pearly white Phonones-vibration of head of sperm to determine location of ovum Sperm should penetrate corona radiata and zona pellocida. VII. 15th day. GnRH/FSHRF ± stimulates the anterior pituitary gland to release FSH Functions of FSH: 1. 14th day estrogen level is increased while the progesterone level is increased causing rupture of graffian follicle on process of ovulation. marks ovulation day. Functions of LH: 1. Follicular Phase ± causing irregularities of mens Postmenstrual Phase Preovulatory Phase ± phase increase estrogen IV. decrease progesterone 14th day ± Increase estrogen. Stages of Sexual Responses (EPOR) Initial responses: . the estrogen level is decreased. hormone for ovulation VI. 2. increase progesterone 15th day ± Decrease estrogen. hypothalamus 2. -phase of increase estrogen.ability of sperm to release proteolytic enzyme to penetrate corona radiata and zona pellocida. increase progesterone I.
nipple erection) ± erotic stimuli cause increase sexual tension. 3. Done early in pregnancy. Morula ± mulberry-like ball with 16 ± 50 cells. Orgasm ± (involuntary spasm throughout body. Ex missing digits/toes. Chorionic Villi. lasts minutes to hours. Fertilization B. Dicidua ± 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.2 months to birth. Adhesion 3. Zygote. Apposition 2. RR. 4. Stages of Fetal Growth and Development 3-4 days travel of zygote ± mitotic cell division begins *Pre-embryonic Stage a.fertilized ovum. Excitement Phase ± (sign present in both sexes.if with fertilization ± corpus luteum continues to function & become source of estrogen & progesterone while placenta is not developed.occurs after fertilization 7 ± 10 days. 3 processes of Implantation 1. . Resolution ± (v/s return to normal.most affected are is pelvic area.Vasocongestion ± congestion of blood vessels Myotonia ± increase muscle tension 1. Lifespan of zygote ± from fertilization to 2 months b. 2. Common complication fetal limb defect. wherein he cannot be restimulated for about 10-15 minutes A. May last 2 ± 10 sec. 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.10 ± 11th day. sex flush. peak v/s) involuntary release of sexual tension with physiologic or psychologic release. slight pain 2.BP. Lasts 30 seconds ± 3 minutes. genitals return to pre-excitement phase) Refractory Period ± the only period present in males. Implantation/ Nidation. slight vaginal spotting . 4 days free floating & multiplication c. placenta previa ± implantation at low side of uterus Signs of implantation: 1. Blastocyst ± covering of blastocys that later becomes placenta & trophoblast d. Fetus. Blastocyst ± enlarging cells that forms a cavity that later becomes the embryo. Plateau Phase ± (accelerated V/S) ± increasing & sustained tension nearing orgasm. C. immeasurable peak of sexual experience. moderate increase in HR. Invasion C.
decrease amt of fluid ± kidney disease Diagnostic Tests for Amniotic Fluid A.E. 1. clear. 20 ± 21´. Paper turns yellow. B. increased amt of fluid oligohydramnios. Amnioscopy ± direct visualization or exam to an intact fetal membrane. 15 ± 55cm. Amnion ± inner most layer a. *Function of Amniotic Fluid: 1. help in delivery process normal amt of amniotic fluid ± 500 to 1000cc polyhydramnios.determine if amniotic fluid has ruptured or not (blue paper turns green/grey . Cytotrophoblast ± inner layer or langhans layer ± protects fetus against syphilis 24 wks/6 months ± life span of langhans layer increase. Genetic screening. facilitates musculo-skeletal development 3. odor mousy/musty. Umbilical Cord. prevent cord compression 5. hydramnios. Short cord: abruptio placenta or inverted uterus.+ ruptured amniotic fluid) C.urine. Before 24 weeks critical. Chorion ± where placenta is developed Lecithin Sphingomyelin L/S Ratio.FUNIS. with crystallized forming pattern. Fern Test. Synsitiotrophoblast ± synsitial layer ± responsible production of hormone 1. whitish grey. Nitrazine Paper Test ± diff amniotic fluid & urine. Amniocentesis empty bladder before performing the procedure.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 . might get infected syphilis F.maternal serum alpha feto-protein test (MSAFP) ± 1st trimester 2. fluid is tested for: 1.GIT malformation TEF/TEA. 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. Paper turns blue green/gray-(+) rupture of amn fluid. Amniotic Fluid ± bag of H2O. Long cord:cord coil or cord prolapse b. Purpose ± obtain a sample of amniotic fluid by inserting a needle through the abdomen into the amniotic sac. cushions fetus against sudden blows or trauma 2. slightly alkaline.needle insertion site Aspiration of yellowish amniotic fluid ± jaundice baby Greenish ± meconium A. maintains temp 4.pre term labor Important factor to consider for amniocentesis.
causes softening joints & bones estrogen progestin 3. If mom hypoglycemic.carries waste products. kidneys and repro organ * Ectoderm ± development of brain. Has a diabetogenic effect ± serves as insulin antagonist Relaxin Hormone. Corpus luteum ± source of estrogen & progesterone of infant ± life span ± end of 2nd month 3. glucose transport is facilitated. 1. Human Chorionic Gonadrophin ± maintains corpus luteum alive. Buds of milk teeth appear . 4. Meconium is formed Third Month 1. placenta developed 2. skin and senses. Kidneys functional 2.artery . 5. hair. musculoskeletal system. fetus hypoglycemic Excretory System. CNS develops ± dizziness of mom due to hypoglycemic effect Food of brain ± glucose complex CHO ± pregnant womans food (potato) Second Month 1.for calcium Thymus ± development of immunity Liver ± lining of upper RT & GIT * Mesoderm ± development of heart. Respiratory System ± beginning of lung function after birth of baby. All vital organs formed. Simple diffusion GIT ± transport center. Size: 500g or ½ kg -1 inch thick & 8´ diameter Functions of Placenta: a. 2.Brain & heart development GIT& resp Tract ± remains as single tube 1. It serves as a protective barrier against some microorganisms ± HIV. Fetal heart tone begins ± heart is the oldest part of the body 2. Sex organ formed 4. combination of chorionic villi + deciduas basalis. Circulating system ± achieved by selective osmosis Endocrine System ± produces hormones y y y y y 6. Liver of mom detoxifies fetus.Placenta ± (Secundines) Greek ± pancake.HBV Fetal Stage ³ 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 . nails. mucus membrane or anus & mouth First trimester: 1st month . Human placental Lactogen or sommamommamotropin Hormone ± for mammary gland development. diffusion more rapid from higher to lower.
any drug. Third trimester: Period of most rapid growth. 18. Fourth Month lanugo begins to appear fetal heart tone heard fetoscope. 1. 3. 5. TORCH (Terratogenic) Infections ± viruses . 2. Drugs: Streptomycin ± anti TB & or Quinine (anti malaria) ± damage to 8th cranial nerve ± poor hearing & deafness Tetracycline ± staining tooth enamel. 4. FOCUS: weight of fetus Seventh Month ± development of surfactant ± lecithin 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 1. 2. 18 ± 20 weeks buds of permanent teeth appear Fifth Month lanugo covers body actively swallows amniotic fluid 19 ± 25 cm fetus. hyperbilirubenia or jaundice Iodides ± enlargement of thyroid or goiter Thalidomides ± Amelia or pocomelia. 2. the exposure to such may cause damage to the fetus A. E. absence of extremities Steroids ± cleft lip or palate Lithium ± congenital malformation Alcohol ± lowered weight (vasoconstriction on mom). 2.18 wks ± multi fetal heart tone heard with or without instrument Sixth Month eyelids open wrinkled skin vernix caseosa present 1. 16.20 weeks primi. 4. 3. Quickening. Fetal heart tone heard ± Doppler ± 10 ± 12 weeks Sex is distinguishable Second Trimester: FOCUS ± length of fetus 1. inhibit growth of long bone Vitamin K ± hemolysis (destr of RBC). C.1st fetal movement. 1. fetal alcohol withdrawal syndrome char by microcephaly Smoking ± low birth rate Caffeine ± low birth rate Cocaine ± low birth rate. Terratogens. virus or irradiation. abruption placenta B. 3. D.3. 2. 3.
slight hypertrophy of ventricles. constipation y Monitor for hemorrhage . malunggay. It affects toughly 20% of pregnant women.CHARACTERISTICS: group of infections caused by organisms that can cross the placenta or ascend through birth canal and adversely affect fetal growth and development. black stool.saluyot. green leafy vegetable-alugbati. Z tract. after delivery. increase heart workload.. Don¶t get pregnant for 3 months. 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. ampalaya y Parenteral Iron ( Imferon) ± severe anemia. Other. 3 times a day) empty stomach 1 hr before meals or 2 hrs after.pathologic anemia if lower HCT should not be 33%. give IM.iron deficiency anemia is the most common hematological disorder. Vaccine is terratogenic C ± cytomegalo virus H ± herpes simplex virus VI. influenza like findings. In some chases the infection may go unnoticed in the pregnant woman yet have devastating effects on the fetus. and jaundice (hepatic involvement). Systemic Changes 1. T ± toxoplasmosis ± mom takes care of cats. epistaxis ± due to hyperemia of nasal membrane palpitation. Rubella. Feces of cat go to raw vegetables or meat O ± others. hematoma.5 ± 14g/dL Criteria 1st and 3rd trimester. y Oral Iron supplements (ferrous sulfate 0.easy fatigability. Cytomegalo virus. constipation y Slowed capillary refill y Concave fingernails (late sign of progressive anemia) due to chronic physio hypoxia Nursing Care: y Nutritional instruction ± kangkong. liver due to ferridin content. Herpes simples virus.5% pathologic anemia if lower Pathogenic Anemia . Physiologic Anemia ± pseudo anemia of pregnant women Normal Values Hct 32 ± 42% Hgb 10. Hepa A or infectious heap ± oral/ fecal (hand washing) Hepa B. . Hgb should not be < 11g/dL 2nd trimester ± Hct should not <32% Hgb Shdn't < 10.Assessment reveals: y Pallor. mom will be given rubella vaccine. enlarged lymph nodes. Physiological Adaptation of the Mother to Pregnancy A. horseradish. rashes and lesions. TORCH: Toxoplasmosis.if improperly administered. These infections are often characterized by vague.3 g. Cardiovascular System ± increase blood volume of mom (plasma blood) 30 ± 50% = 1500 cc of blood .
apple with skin. proper body mechanical increase salivation ± ptyalsim ± mgt mouthwash . Except guava ± has pectin that¶s constipating ± veg ± petchy.) 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. avoid wearing knee high socks . protamine sulfate Avoid aspirin! Might aggravate bleeding.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. Respiratory system ± common problem SOB due to enlarged uterus & increase O2 demand Position.) 5. Nausea afternoon . y Gastrointestinal ± 1st trimester change Morning Sickness ± nausea & vomiting due to increase HCG. cantaloupe. 3. 2. Varicosities ± pressure of uterus .fruits ± papaya. Vomiting in preg ± emesisgravida.painful. Metabolic alkalosis.) 6. F&E imbalance ± primary med mgt ± replace fluids.use elastic bandage ± lower to upper Vulbar varicosities.) 4. pressure on gravid uterus.lateral expansion of lungs or side lying position.small frequent feeding. increase fiber diet . Increase fluid intake. elevate legs above hip level. watermelon. malungay. Eat dry crackers or dry CHO diet 30 minutes before arising bed. Monitor I&O constipation ± progesterone resp for constipation.Alert: y y y 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. to relieve.) 3.exercise -mineral oil ± excretion of fat soluble vitamins * Flatulence ± avoid gas forming food ± cabbage * Heartburn ± or pyrosis ± reflux of stomach content to esophagus .position ± side lying with pillow under hips or modified knee chest position Thrombophlebitis ± presence of thrombus at inflamed blood vessel . . avoid fatty & spicy food. sips of milk. suha. mango.use support stockings.small freq feeding. avoid 3 full meals. pineapple.) 2.increase clotting factor .pregnant mom hyperfibrinogenemia .increase fibrinogen .
no alcohol ± has antibuse effect VAGINAL DOUCHE ± IQ H2O : 1 tbsp white vinegar b. mousy odor discharge ESTROGEN ± hormone. Vit D for increased Ca absorption dorsiflexion B. crab. over fatigue. 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. brocolli. fungal infection. yogurt. cotrimaxole. genshan violet. 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 Mgt: FLAGYL ± (metronidazole ± antiprotozoa).condifoma acuminata due to papilloma virus Mgt: cauterization . head of fish. PROGESTERONE ± hormone responsible for operculum PREGNANT ± acidic to alkaline change to protect bacterial growth (vaginitis) Problems Related to the Change of Vaginal Environment: a. Dilis.*Hemorrhoids ± pressure of gravid uterus. oversex. hot sitz bath for comfort 4. Mgt. lobster. Cheese. 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. canesten Gonorrhea -Thick purulent discharge Vaginal warts. 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. Moniliasis or candidiasis due to candida albecans. Signs & Symptoms: Management ± antifungal ± Nistatin. Ca & phosphorous imbalance(#1 cause while pregnant). treat dad also to prevent reinfection 2. Carcinogenic drug so don¶t give at 1st trimester 1. resp for leucorrhea OPERCULUM ± mucus plug to seal out bacteria. seafood-tahong (mussels). Color ± white cheese like patches adheres to walls of vagina. sardines with bones. 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 Musculoskeletal 5. chills.
Skin Changes ± brown pigmentation nose chin. nutrition .2. Brown pinkish line. Developmental task is to accept biological facts of pregnancy Focus: bodily changes of preg.linea nigra.change of consistency of cervix Urinary freq Chadwick¶s. umbilicus is protruding 3. Objective C. color of areola & nipple pre colostrums present by 6 weeks. Signs & symptoms of Pregnancy A. Positive Signs ± undeniable signs confirmed by the use of instrument. Ballotment sign of myoma * + HCG ± sign of H mole .7 days after mens ±± supine with pillow at back quadrant B ± upper outer ± common site of cancer Test to determine breast cancer: 1. Empty bladder . use coconut oil. cheeks ± chloasma melasma due to increased melanocytes.there is calcium Presumptive Probable Breast changes Goodel's. ambivalence.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 . Probable ± signs observed by the members of health team. surprise.symphisis pubis to umbilicus 4.trans vaginal ultrasound. denial ± sign of maladaptation to pregnancy. Ovaries ± rested during pregnancy 7. Psychological Adaptation to Pregnancy (Emotional response of mom ±Reva Rubin theory) First Trimester: No tanginal signs & sx.change of consistency of isthmus Amenorrhea Elevated BBT ± due to increased progesterone Morning sickness Positive HCG or (+)preg test Enlarged uterus Ballottement ± bouncing of fetus when lower uterine is Cloasma tapped sharply Linea negra Enlarged abdomen Increased skin Braxton Hicks contractions ± painless irregular contractions pigmentation Striae gravidarium Quickening Positive Ultrasound evidence (sonogram) full bladder Fetal heart tone Fetal movement Fetal outline Fetal parts palpable VII. Abdominal Changes ± striae gravidarium (stretch marks) due enlarging uterus-destruction of sub Q tissue ± avoid scratching. mammography ± 35 to 49 yrs once every 1 to 2 yrs 50 yrs and above ± 1 x a yr 6. Presumptive ± s/s felt and observed by the mother but does not confirm positive diagnosis of pregnancy . colostrums at 3rd trimester Breast self exam.blue violet discoloration of vagina Fatigue Hegar's. Subjective B. Breast Changes ± increase hormones.
# of viable pregnancy Viability ± the ability of the fetus to live outside the uterus at the earliest possible gestational age.) urine exam to detect HCG at 40 ± 100th day. age of viability . Home base mom¶s record.5 ± 1lb/month) (4 lbs/month) (1 lb/wk) (4 lbs/ month) ( 1lb/wk) 4. Pre-Natal Visit: 1.# of pregnancy b.best to get urine exam. (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. Gravida. Sex ( pseudocyesis or false pregnancy on men & women) Couvade syndrome ± dad experiences what mom goes through ± lihi) Address. Developmental task ± accept growing fetus as baby to be nurtured. religion. 60 ± 70 day peak HCG.) Home preg kit ± do it yourself Baseline Data: V/S esp. Personal data ± name. Obstetrical Data: nullipara ± no pregnancy a. 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 2.5 ± 3 lbs 10 ± 12 lbs 10 ± 12 lbs (. BP.) Elisa test ± test for preg detects beta subunit of HCG as early as 7 ± 10days 3. 6 weeks after LMP. education background ± level knowledge 3. Third Trimester: . fantasy. Diagnosis of Pregnancy 1.mom has personal identification on appearance of baby Development task: prepare of birth & parenting of child. 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 . Health teaching: growth & development of fetus.Second Trimester ± tangible S&Sx. Most common fear ± let mom listen to FHT to allay fear Lamaze classes VII. mom identifies fetus as a separate entity ± due to presence of quickening. civil status.20 ± 24 wks Term 37 ± 42 wks. non judgmental Occupation ± financial condition or occupational hazards. monitor wt. age (high risk < 18 & >35 yrs old) record to determine high risk ± HBMR. 2. Para . culture & beliefs with respect. HT: responsible parenthood µbaby¶s Layette´ ± best time to do shopping.
2nd ½ of preg tetanus immunizations ± prevents tetanus neonatum -mom with complete 3 doses DPT young age considered as TT1 & 2. Nagele¶s Rule ± use to determine expected date of delivery Get LMP -3+ 7 +1 Apr-Dec LMP ± Jan Feb Mar M D Y +9 +7 no year LMP Jan 25. 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 3.1 add 1 month to month 11/31/04 EDD 2. 04 +9 +7 10 / 32 / 04 .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. Bartholomew¶s Rule ± to determine age of gestation by proper location of fundus at abdominal cavity. square @ month 2nd ½ of preg. Formula: 1st ½ of preg . 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 7 x 5 = 35 cm 8 x 5 = 40 cm 9 x 5 = 45 cm d. Begin TT3 TT1 ± any time during pregnancy TT2 ± 4 wks after TT1 ± 3 yrs protection . 3 months ± above sym pub 5 months ± level of umbilicus 9 months ± below zyphoid 10 months ± level of 8 months due to lightening 4. Important Estimates: GP GTPAL 4 2 4 11 1 1 GP GTPAL 6 4 6 2 2 15 1. Haases rule ± to determine length of the fetus in cm.
normal Class IIA ± acytology but no evidence of malignancy B ± suggestive of infl. empty bladder 2. E ± edema to upper ext. degree of descent. 2. abortion. fetal presentation lie. Prep mom: 1. 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 .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.TT3 ± 6 months after TT2 ± 5 yrs protection TT4 ± 1 yr after TT3 ± 10 yrs protection TT5 ± yr after TT4 ± lifetime protection 5. Examine teeth: sign of infection Danger signs of Pregnancy C . ectopic pre/2nd ± H mole. position. Procedure: Empty bladder Position of mom-supine with knee flex (dorsal recumbent ± to relax abdominal muscles) 6. . Physical Examination: A. and number of fetuses. Leopold¶s Maneuver Purpose: is done to determine the attitude. incompetent cervix 3rd ± placental anomalies S ± sudden gush of fluid ± PROM (premature rupture of membrane) prone to inf.chills/ fever .cancer extends to vagina 3 ± pelvis metastasis 4 ± affection to bladder & rectum 7.use palm! Warm palm. (preeclampsia) Pelvic Examination ± internal exam 1. presenting part. universal precaution EXT OS of cervix ± site for getting specimen Site for cervical cancer Pap Smear ± cervical cancer . fetal back & fetal heart tone .composed of squamous columnar tissue Result: Class I . an estimate of the size.
begin after meal . Assess whether the presenting part is engaged in the pelvis )Alert : if the head is engaged it will not be movable). With two hands. To determine attitude ± relationship of fetus to 1 another. movement and firmness of the part to determine presentation 2nd Maneuver: with both hands moving down. diabetes b. Uterine soufflé ± maternal H rate 3rd Maneuver: using the right hand. inadequate nutrition Procedure: .) more then 1 hour to reach 10 movements b. Assess size. identify the back of the fetus ( to hear fetal heart sound) where the ball of the stethoscope is placed to determine FHT.Assessment of Fetal Well-BeingA. often require further testing.breakfast a.fetal distress) c. grasp the symphis pubis part using thumb and fingers. Daily Fetal Movement Counting (DFMC) ±begin 27 weeks Mom. shape. Cardiff count to 10 method ± one method currently available (1) Begin at the same time each day (usually in the morning. the head will be flexed and vertex presenting. assess the descent of the presenting part by locating the cephalic prominence or brow. Attitude ± relationship of fetus to a part ± or degree of flexion Full flexion ± when the chin touches the chest 8. To determine degree of engagement.) maternal history of smoking. with both hands palpate upper abdomen and fundus. less vigorous Movement alarm signals . Get V/S(before 2nd maneuver) PR to diff fundic soufflé (FHR) & uterine soufflé. biographical profile (BPP) B.) movement are becoming weaker. Nonstress test ± to determine the response of the fetal heart rate to activity Indication ± pregnancies at risk for placental insufficiency Postmaturity a. When the brow is on the same side as the back. put towel under head and right hip. 4th Maneuver: the Examiner changes the position by facing the patient¶s feet.) longer time to reach 10 FMs than on previous days d. 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.) warning signs should be reported to healthcare provider immediately. the head is extended. Examples: nonstress test (NST).< 3 FMs in 12 hours 4.) less then 10 movements in 12 hours(non-reactive. When the brow is on the same side as the small parts.) pregnancy induced hypertension (PIH).1st maneuver: place patient in supine position with knees slightly flexed.) warning signs noted during DFMC c. after breakfast) and count each fetal movement.
mother activates the ³mark button´ on the electronic monitor when she feels fetal movement.CHON x4. 2. Low socio ± economic status 4. 4. Baseline FHR between 120 and 160 beats per minute 2. (BPP) or contraction stress test (CST) 9. Extremes in wt ± underweight. Nutrition ± do nutritional assessment ± daily food intake High risk moms: 1. Vegetarian mom ± decrease CHON ± needs Vit B12 ± cyanocobalamin ± formation of folic acid ± needed for cell DNA & RBC formation. Nonreactive result 1. Requires further evaluation with another NST. result indicates a healthy fetus with an intact nervous system i. Pregnant teenagers ± low compliance to heath regimen.utilization of nutrients activity level . DM 3.Foods of high nutrient value such Essential to supply energy for to maintain ideal body weight as protein. biophysical profile.protein sparing so it can be used . tocotransducer over fundus to detect uterine contractions and fetal movements (FMs) 2. monitor until at least 2 FMs are detected in 20 minutes y if no FM after 40 minutes provide woman with a light snack or gently stimulate fetus through abdomen y if no FM after 1 hour further testing may be indicated.Done within 30 minutes wherein the mother is in semi-fowler¶s position (w/ fetal monitor).Use weight ± gain pattern . (Decrease folic acid ± spina bifida/open neural tube defect) How many Kcal CHO x4.Development of structures . lasting at least 15 seconds in a 10 to 20 minute period as a result of FM 3. complex carbohydrates .increased metabolic rate and meet energy requirement to (whole grains. fruits) . ii. At least two accelerations of the FHR of at least 15 beats per minute. such as a CST Result: Noncreative Nonstress Not Good Reactive Responsive is Real Good Interpretation of results reactive result 1. Could be indicative of a compromised fetus.Begin increase in second sources for the nutrients requiring for trimester during pregnancy . Health teachings a. external monitor is applied to document fetal activity. fats x 9 Recommended Nutrient Requirement that increases During Pregnancy Nutrients Requirements Food Source 300 calories/day above the Caloric increase should reflect Calories prepregnancy daily requirement . vegetables. Attach external noninvasive fetal monitors 1.Growth of fetus . ultrasound transducer over abdominal site where most distinct fetal heart sounds are detected 3.No more than 30% fat . Stated criteria for a reactive result are not met 2.Variety of foods representing foods . over wt ± candidate for HPN. noted as an uneven line on the rhythm strip. Good variability ± normal irregularity of cardiac rhythm representing a balanced interaction between the parasympathetic (decreases FHR) and sympathetic (increase FHR) nervous system.
liver.vitamin C sources: citrus fruits & juices. eggs .Whole grains * vegetarians must take note of the amino acid content of CHON foods consumed to ensure ingestion of sufficient quantities of all amino acids Calcium increases of . whole grain cereals and breads . poultry.Current research is : Demonstrating an association between adequate calcium intake and the prevention of pregnancy induce hypertension Iron Essential for . ketosis has been associated with fetal damage. potatoes . since diet alone is unable to meet pregnancy requirement . as an indication of adequacy of calorie intake.Vitamin D sources: fortified milk.dairy products : milk.Maintenance of mineralization of maternal bones and teeth . . lentils. amniotic fluid.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.canned salmon & sardines w/ bones .70 mg/day of vitamin C which enhances iron absorption .Eggs.Maternal tissue growth including uterus and breasts . . cheese.Dried beans. egg yolk .green leafy vegetables .Lean meat.required for pregnancy including placenta.Development of essential pregnancy structures .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 . legumes . fish.Begin supplementation at 30.whole grains.1200 mg/day representing an increase of 50% above prepregnancy daily requirement.Ca fortified foods such as orange juice . margarine. cheese.nuts. broccoli or cabbage. dried fruits .mg/day in second trimester. cantaloupe. strawberries. Protein Essential for: . fish .Fetal tissue growth . tofu .1600 mg/day is recommended for the adolescent.dark green leafy vegetables. 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 .inadequate iron intake results in maternal effects ± anemia depletion of iron Calcium increases should reflect: .iron from food sources is more readily absorbed when served with foods high in vit C .enriched.Expansion of blood volume and red blood cells formation .Growth and development of fetal skeleton and tooth buds . egg yolk.Establishment of fetal iron stores for first few months of life 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 for their own growth as well as protein t meet the pregnancy requirement Protein increase should reflect . yogurt. butter. . red meat.liver. ice cream.Failure to meet caloric requirements can lead to ketosis as fat and protein are used for energy. nuts . seafood Iron increases should reflect . poultry. milk . and tissue growth.
15mcg/day representing an increase of 3 mg/day over prepreganant daily requirements.) 2nd trimester ± increased desire due to increase estrogen that enhances lubrication c. nuts Increases should reflect . incompetent cervix .eggs. Folic Acid. abruption placenta Additional Requirements Minerals .5 mg/day 1.air embolism Changes in sexual desire: a.2 mg day 17 mg/day Increased requirements of pregnancy can easily be met with a balanced diet that meets the requirement for calories and includes food sources high in the other nutrients needed during pregnancy. cardiac stress especially labor and birth .liver. sidelying or mom on top d.dark green leafy vegetables. lean beef. cheese . .fetal effects decreased availability of oxygen thereby affecting fetal growth * iron deficiency anemia is the most common nutritional disorder of pregnancy.shell fish . Folacin.Whole grains.Sexual Activity a. kidney. abortion. vaginal spotting 1st trimester ± threatened abortion 2nd trimester± placenta previa 2. broccoli.2 mg/day 2.Selenium Vitamins E Thiamine Riborlavin Pyridoxine ( B6) B12 Niacin stores. legumes. Vit stored in body. Folate Essential for . Hard to excrete.liver. veal .) changes in sexual desire of mom during preg.6 mg/day 2. milk.whole grains.) avoid blowing or air during cunnilingus f. 2.formation of red blood cells and prevention of anemia . Taking it not needed ± fat soluble vitamins.) should be done in moderation b. peanuts 400 mcg/day representing an increase of more then 2 times the daily prepregnant requirement.) avoided 6 weeks prior to EDD e. Zinc increases should reflect . legumes.) 3rd trimester ± decreased desire Contraindication in sex: 1. decreased energy and appetite.Magnesium .Zinc Essential for * the formation of enzymes * maybe important in the prevention of congenital malformation of the fetus.DNA synthesis and cell formation. may play a role in the prevention of neutral tube defects (spina bifida). meats .) 1st tri ± decrease desire ± due to bodily changes b.) should be done in private place c. 300mcg/day supplement for women with low folate levels or dietary deficiency 4 servings of grains/day 175 mcg/day 320 mg/day 65 mcg/day 10 mg/day 1.iodine .) mom placed in comfy pos.
preterm labor 4.exercise ± relieves low back pain & maintain good posture * arch back ± standing or kneeling. exhale mouth 3.) Done in moderation. Psychoprophylaxis ± prevention of pain 1. imaging ± sensate focus 5. Psychophysical 1. conditioning & concentration. Different Methods of delivery: 1. Based on imitation of nature. Conscious relaxation 2. Husband is coach Features: 1.) darkened rm 2. Increase circulation to perineum. Grantly Dick Read Method ± fear leads to tension while tension leads to pain b. Robert Bradley ± advocated active participation of husband at delivery process.) relaxation tech 4. Squatting ± strengthen muscles of perineum.flow with contraction than struggle with contraction c. Kitzinger method ± preg.3.) Must be individualized Walking ± best exercise 3. helping them achieved a satisfying and enjoying childbirth experience. Psychosexual 1. a. 2.as if hold urine.strengthen chest muscles pelvic rocking/pelvic tilt. Four extremities on floor Kegel Exercise ± strengthen pulococcygeal muscles . Features: 1. disciple. Lamaze: Dr. premature rupture of membrane Exercise ± to strengthen muscles used during delivery process principles of exercise 1.) closed eye & appearance of sleep 2. labor & birth & care of newborn is an impt turning pt in woman¶s life cycle . Effleurage ± gentle circular massage over abdominal to relieve pain 4. Cleansing breathe ± inhale nose. Childbirth Preparation: Overall goal: to prepare parents physically and psychologically while promoting wellness behavior that can be used by parents and family thus. 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.) birthing chair ± bed convertible to chair ± semifowlers . Ferdinand Lamaze req. Bradley Method ± Dr.) quiet environment 3. release 10x or muscle contraction Abdominal Exercise ± strengthens muscles of abdominal ± done as if blowing candle 4.
biparietal ± largest transverse . Passageway Mom 1. Passenger a. 12 ± 18 months after birth. b.) birthing bed ± dorsal recumbent pos squatting ± relives low back pain during labor pain leboyers ± warm. dark. Admitting the laboring Mother: Personal Data: name.occiput T ± temporal P ± parietal 2 x Measurement fetal head: 1. Basic knowledge in Intrapartum. bimastoid 7cm smallest transverse Sutures ± intermembranous spaces that allow molding. 1. transverse diameter ± 9. weight Obstetrical Data: gravida # preg. IX. address.) theory of aging placenta ± life span of placenta 42 wks.25cm . decrease progesterone will stimulate contractions & labor 5.) Anteroposterior diameter suboccipitobregmatic 9. After delivery. ± 22 ± 24 wks Physical Exams.) uterine stretch theory ( any hallow organ stretched. para.) progesterone theory ± before labor. etc Baseline Data: v/s esppecially BP. The 4 P¶s of labor 1. diamond shape.) Posterior fontanel or lambda ± triangular shape.) 3.viable preg. Birth under H20 ± bathtub ± labor & delivery ± warm water. 4. 1 x 1 cm. Fetal head ± is the largest presenting part ± common presenting part ± ¼ of its length.) Underwent pelvic dislocation . soft music.) 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. baby gets warm bath.) oxytocin theory ± post pit gland releases oxytocin. comfy room.contraction 4.2. b. Closes ± 2 ± 3 months.) 4.sinciput E ± ethmoid O ± occuputal .) 5.) < 4¶9´ tall 2. At 36 wks degenerates (leading to contraction ± onset labor).) sagittal suture ± connects 2 parietal bones ( sagitna) 2. quiet. age.) prostaglandin theory ± stimulation of arachidonic acid ± prostaglandin. Hypothalamus produces oxytocin 3.close 2.) coronal suture ± connect parietal & frontal bone (crown) 3. smallest AP occipitofrontal 12cm partial flexion occipitomental ± 13.) < 18 years old 3.Pelvic Exams B. 1 Theories of the Onset of Labor 1. will always contract & expel its content) ± contraction action 2. 3 x 4 cm.) Anterior fontanel ± bregma. complete flexion.( > 5 cm ± hydrocephalus).2. Intrapartal Notes ± inside ER A.5 cm hyper extension submentobragmatic-face presentation 2. Bones ± 6 bones S ± sphenoid F ± frontal .5 cm.bitemporal 8 cm 2.
Obstetrical conjugate ± smallest AP diameter. oval shape. Increase Activity of the Mother. Pelvis 2 hip bones ± 2 innominate bones 3 Parts of 2 Innominate Bones Ileum ± lateral side of hips . 1. intensity 4. posterior part shallow 3. (DC ± 11. ape like pelvis.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 1.2 weeks prior to EDD * Engagement. Characteristics: wave like d.5 cm=true conjugate) 2.anterior part pointed. Lightening ± setting of presenting part into pelvic brim . AP diameter wider transverse narrow 4.nesting instinct.0 cm 3.5 ± 3 lbs 6. Pelvis at 10 cm or more. deeper most suitable (normal female pelvis) for pregnancy 2. Involuntary Contractions b.5 cm basis in getting true conjugate. Timing: frequency. Ripening of the Cervix ± butter soft 5. Braxton Hicks Contractions ± painless irregular contractions 3. Past Experience d. 3.5 cm . Measurement: 11. Diagonal Conjugate ± measure between sacral promontory and inferior margin of the symphysis pubis. transverse ± wider b. True conjugate/conjugate vera ± measure between the anterior surface of the sacral promontory and superior margin of the symphysis pubis. Check FHT .iliac crest ± flaring superior border forming prominence of hips Ischium ± inferior portion .setting of presenting part into pelvic inlet 2. will be used for delivery.12. Rupture of Membranes ± rupture of water. Tuberoischi Diameter ± transverse diameter of the pelvic outlet.Pelvis 4 main pelvic types 1. Preparation c. Support System Pre-eminent Signs of Labor S&Sx: . Voluntary bearing down efforts c. Increase epinephrine 4.urinary freq. Psyche/Person ± psychological stress when the mother is fighting the labor experience a. Gynecoid ± round. wide. Ischial tuberosity ± approximated with use of fist ± 8 cm & above. Measurement: 11. Android ± heart shape ³male pelvis´. Power ± the force acting to expel the fetus and placenta ± myometrium ± powers of labor a. decreased body wt ± 1. Platypelloid ± flat AP diameter ± narrow. duration. Anthropoid ± oval.shooting pain radiating to the legs . Save energy. Bloody Show ± pinkish vaginal discharge ± blood & leukorrhea 7. Cultural Interpretation b.
Nursing Interventions in Each Stage of Labor 2 segments of the uterus 1. Count pulsation of cord for FHT 4.fundus 2. upper uterine .Premature Rupture of Membrane ( PROM) . Cover cord with sterile gauze with saline to prevent drying of cord so cord will remain slippery & prevent cord compression causing cerebral palsy. lower uterine ± isthmus . Use % in unit of measurement Dilation ± widening of cervix. Danger signs: PROM Presenting part has not yet engaged Fetal distress Protruding cord form vagina Nursing care: 1. 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. 2. especially if fetal distress is noted Cord Prolapse ± a complication when the umbilical cord falls or is washed through the cervix into the vagina. 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 abdomen Pain ± begins lower back radiates to abdomen Pain ± relived by walking Pain ± intensified by walking No cervical changes Cervical effacement & dilatation * major sx of true labor. Unit used is cm. Duration of Labor Primipara ± 14 hrs & not more than 20 hrs Multipara ± 8 hrs & not > 14 hrs Effacement ± softening & thinning of cervix.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. Slip cord away from presenting part 3.
1 station = presenting part 1cm above ischial spine if (-) floating . Encourage to void q 2 ± 3 hrs ± full bladder inhibit contractions 3. cervical dilation and effacement.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. 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. Longitudinal Lie ( Parallel) cephalic Vertex ± complete flexion Face Brow Poor Flexion Chin . 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.shorten 1st stage of labor 2. First Stage: onset of true contractions to full dilation and effacement of cervix. 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. Station ± landmark used: ischial spine . Breathing ± chest breathing Active Phase: Assessment: Dilations 4 -8 cm Intensity: moderate Mom.1.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. can communicate Frequency: every 5 ± 10 min Intensity mild Nursing Care: 1. apprehensive. Encourage walking . fetal monitor.1. Latent Phase: Assessment: Dilations: 0 ± 3 cm mom ± excited.
c.2. LADP. let mom rest.)To cleanse bowel b. Variety: Occipito ± LOA left occipito ant (most common and favorable position)± side of maternal pelvis LOP ± left occipito posterior LOP ± most common mal position.)Sims position/side lying 12 ± 18 inch ± ht enema tubing .) Ok to shower 2.Breech - Complete Breech ± thigh breast on abdomen. Transverse Lie (Perpendicular) or Perpendicular lie. Shoulder presentation. double Kneeling b. most painful ROP ± squatting pos on mom ROT ROA Breech. LADT. if same BP.)NPO ± GIT stops function during labor if with food. 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. 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 . breast lie on thigh Incomplete Breech ± thigh rest on abdominal Frank ± legs extend to head Footling ± single. RST. LMT.put stet above umbilicus Shoulder/acromniodorso LADA.use sacrum . RMT. RSP Chin / Mento LMA. RSA.)Prevent infection c. RADA LSA ± left sacro anterior LST.will cause aspiration 3. LMP. LSP.)Enema administer during labor a. If BP increase . notify MD -preeclampsia Health teachings 1.strength of contraction Contraction ± vasoconstriction Increase BP. RMP. Position ± relationship of the fatal presenting part to specific quadrant of the mother¶s pelvis. RMA.
slow to heal -use local or pudendal anesthesia.to prevent laceration. Nursing Care: To prevent puerperal sepsis . supports uterus during pregnancy Linea Terminales diagonal imaginary line from the sacrum to the symphysis pubis that divides the false and true pelvis.) Will facilitate complete flexion & extension.) fetal thrushing ± hyperactive fetus due to lack O2 2. Pull shoulder down & up. complete dilation and effacement to birth. Ironing the perineum ± to prevent laceration Modified Ritgens maneuver ± place towel at perineum 1.)To prevent laceration 2. True pelvis ± below the pelvic inlet 2. Inlet ± AP diameter narrow. Mechanisms of labor 1. identification of baby. Flexion 4. False pelvis ± above the pelvic inlet. Lengthening of the cord 3. Cavity Two Major Divisions of Pelvis 1. Second Stage: fetal stage.) <120 & >160 2. Check time. check cord if coiled. External rotation 7. shorten 2nd stage of labor. transverse diameter wider 2. hard to repair.) mecomium stain amnion fluid 3. (Support head & remove secretion. Fundus rises ± becomes firm & globular ³ Calkins sign´ 2.< 48 hours only ± vaginal pack Bolus of Ptocin can lead to hypotension. Third Stage: birth to expulsion of Placenta -placental stage Placenta delivered from 3-10 minutes Signs of placental separation 1. Engagement 2. fast to heal. Expulsion Three parts of Pelvis ± 1. Episiotomy ± median ± less bleeding. 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. widen vaginal canal. Descent 3. less pain easy to repair. Extension 6. Internal Rotation 5. possible to reach rectum ( urethroanal fistula) Mediolateral ± more bleeding & pain. placenta has 15 ± 28 cotyledons .Check FHT after adm enema Normal FHT= 120-160 Signs of fetal distress1.
) Partial rooming in: baby in morning .edness E. Chills-due dehydration. massage uterus) 6.) hypertonic or primary uterine inertia ./diazepam ± muscle relaxant 2. . Check completeness of placenta. Sudden gush of blood Types of placental delivery Shultz ³shiny´ ± begins to separate from center to edges presenting the fetal side shiny Dunkan ³dirty´ ± begin to separate form edges to center presenting natural side ± beefy red or dirty Slowly pull cord and wind to clamp ± BRANDT ANDREWS MANEUVER Hurrying of placental delivery will lead to inversion of uterus.intense excessive contractions resulting to ineffective pushing .slow irregular contraction resulting to ineffective pushing. Bonding ± interaction between mother and newborn ± rooming in types 1. Blanket. Flat on bed 12.) hypotonic ± secondary uterine inertia.3. Nsg care for placenta: 4. clear gelatin. ginger ale. Administer methergine IM (Methylergonovine Maleate) ³Ergotrate derivatives 8. Fully soaked pad : 30 ± 40 cc weigh pad. Lochia d.cchemosis D ± ischarges A ± approximation of blood loss. Monitor v/s q 15 for 1 hr.dema E . Let mom sleep to regain energy. 1 gram=1cc e. Perineum ± R . Check bp 7. Maternal Observations ± body system stabilizes b.) Straight rooming in baby: 24hrs with mom.) Check lochia a. If fundus above umbilicus.MD administer sedative valium. give clear liquid-tea. Give oxytocin. Monitor hpn (or give oxytocin IV) 9.) Empty bladder to prevent uterine atony 2. Check placement of fundus at level of umbilicus. Placement of the Fundus c. 5. 2nd hr q 30 minutes. Check perineum for lacerations 10. Fourth Stage: the first 1-2 hours after delivery of placenta ± recovery stage. 2. at night nursery Complications of Labor Dystocia ± difficult labor related to: Mechanical factor ± due to uterine inertia ± sluggishness of contraction 1. deviation of fundus 1. Check fundus (if relaxed. Assist MD for episiorapy 11. Count pad & saturation 4.
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 Tachycardia Tachypnea Cold clammy skin Inversion of the uterus ± situation uterus is inside out. Fetal effect ± fetal distress.)Large baby 3.) short cord 2. chest pain & frothy sputum prepare: suctioning end stage: DIC disseminated intravascular coagopathy. Mom given 6 hrs of labor Multi: 8 ± 14.labor of < 3 hrs.) TAHBSO Physiologic retraction ring . primi 14 ± 20 Preterm Labor ± labor after 20 ± 37 weeks) ( abortion <20 weeks) Sx: 1. caput succedaneum or cephal hematoma .) Improper use of oxytocin (IV drip) Sx: a.) profuse bleeding c. hypovolemic shock if with bleeding. nose.nsg care: monitor contractions and FHR Precipitate Labor . profuse bleeding.Prolonged labor ± normal length of labor in primi 14 ± 20 hrs Multi 10 -14 hrs > 14 hrs in multi & > 20 hrs in primi .) 1.) sudden pain b.maternal effect ± exhaustion.bleeding to all portions of the body ± eyes.) hurrying of placental delivery 3. extensive lacerations.)Previous classical CS 2. Factors leading to inversion of uterus 1.Boundary bet upper/lower uterine segment BANDL¶S pathologic ring ± suprapubic depression a.) 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.) ineffective fundal pressure Uterine Rupture Causes: 1. etc.) hypovolemic shock d. MD will push uterus back inside or not hysterectomy. premature contractions q 10 min . Trial Labor ± measurement of head & pelvis falls on borderline.
dilation saved by administer Tocolytic agents.early ambulation Principles underlying puerperium 1. Uterus ± return to normal 6 ± 8 wks.000 cumm Puerperium ± covers 1st 6 wks post partum Involution ± return of repro organ to its non pregnant state. dilation 2-3 cm Home Mgt: 1. complete bed rest 2. birth pain: 1.<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 .YUTOPAR. Postpartal Period 5th stage of labor after 24hrs :Normal increase WBC up to 30. 2.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.(puerperal sepsis).2. If cervix is closed 2 ± 3 cm. To return to Normal and Facilitate healing A.1.Yutopar Hcl) 150mg incorporated 500cc Dextrose piggyback. This is critical especially to gravidocardiac mothers. Physiologic Changes a. Cardiovascular System . X. 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. effacement of 60 ± 80% 3. consult MD if symptoms persist Hosp: 1. Systemic Changes 1. Hyperfibrinogenia . drink 3 -4 glasses of water ± full bladder inhibits contractions 5.D&C after. Genital tract a. Monitor: FHT > 180 bpm Maternal BP . position prone . empty bladder 4.prone to thrombus formation . Vaginal and Pelvic Floor c. avoid sex 3. Cervix ± cervical opening b.a medium for bacterial growth.beta-blocker If cervix is open ± MD ± steroid dextamethzone (betamethazone) to facilitate surfactant maturation preventing RDS Preterm-cut cord ASAP to prevent jaundice or hyperbilirubenia.halts preterm contractions.
Baggy or relaxed uterus & profuse bleeding ± uterine atony. Complications: hypovolemic shock. hot sitz bath.stimulate bladder 3. musty/mousy. deciduas.proper hygiene b. Colon: Constipation ± due NPO.urinary retention with overflow 4. Provide Emotional Support ± Reva Rubia Psychological Responses: a. mefenamic acid d. can make decisions HT: 1. cant make decisions.) 2.inability to sleep & lack of appetite. Alba ± créme white 10 ± 21 days very decreased amt dysuria .) Insert family planting method common post partum blues/ baby blues present 4 ± 5 days 50-80% moms ± overwhelming feeling of depression characterized by crying. Nursing Care: . Hemorrhage ± bleeding of > 500cc CS ± 600 ± 800 cc normal NSD 500 cc Early postpartum hemorrhage± bleeding within 1st 24 hrs.when perineum has healed II.) 1st degree laceration ± affects vaginal skin & mucus membrane. activity is to tell child birth experiences. c. ± let mom cry ± therapeutic.alternate warm & cold compress . Lochia-bld.) 4. Mom is active. Urinary tract: Bladder ± freq in urination after delivery. massage uterus until contracted cold compress modified trendelenberg IV fast drip/ oxytocin IV drip I. Mgt: 1. cold compress ± to prevent bleeding 3.) 3.) Care of newborn 2. III. not compress sex. microorganism.urine collection . Taking hold phase ± dependent to independent phase (4 to 7 days).2. 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.redefines new roles may extend until child grows. Nsd & Cs with lochia. Ruba ± red 1st 3 days present. limited amt 3. wbc. cold compress for immediate pain after 24 hrs. Mom . Letting go ± interdependent phase ± 7 days & above. moderate amt 2. . Prevent complications 1. despondence. fear of bearing down 5. Perineal area ± painful ± episiotomy site ± sims pos. 1. Taking in phase ± dependent phase (1st three days) mom ± passive. Serosa ± pink to brown 4 ± 9th day.
bleeding to any part of body . 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.assess perineum for laceration . Inflammation ± calor (heat).) exogenous ± from outside 1. Natural Method ± the only method accepted by the Catholic Church . percreta. Late Postpartum hemorrhage ± bleeding after 24 hrs ± retained placental fragments Mgt: D&C or manual extraction of fragments & massaging of uterus.) determine one¶s own beliefs 1st 2.) shave 3. Endometriosis ± inflammation of endometrial lining Sx: Abdominal tenderness.failure to coagulate. between & resulting. Acreta ± attached placenta to myometrium.too much manipulation . purulent discharges 3. .) cold compress every 30 minutes with rest period of 30 minutes for 24 hrs 2.) never advice a permanent method of planning 3.) unhealthy sexual practices General signs of inflammation: 1.sources of infection 1. VITC. hydration. rubor (red). D&C except placenta increta. saline.hysterectomy if with abruption placenta mgt: BT. cold compress. paracetamol.degree of laceration .pudendal anesthesia Mgt: 1. Fowlers ± to facilitate drainage & localize infection oxytocin & antibiotic IV.large baby . Hypofibrinogen.mgt episiorapy DIC ± Disseminated Intravascular Coagulopathy. 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. Motivate the use of Family Planning 1. fever Gen mgt: 1.) anaerobic streptococci ± most common . TSB. pos.from members health team 2.) incision on site.) method of choice is an individuals choice.cryoprecipitate or fresh frozen plasma II.) supportive care ± CBR.Well contracted uterus + bleeding = laceration .)endogenous ± from within body 2. scraping & suturing Infection. . dolor (pain) tumor(swelling) 2.
Best method Social Method ± 1.get before arising in bed LAM ± lactation amenorrheal method ± hormone that inhibits ovulation is prolactin.Billings / Cervical mucus± test spinnbarkeit & ferning (estrogen) . . stretchable. Signs of hypertension Immediate Discontinuation A ± abdominal pain C ± chest pain H .least effective method 2. breast feeding. .shortest ± 18 .monitor cycle for 1 year .3 months.9% effective. 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 ± . watery.18 8 Dec 33 -11 22 unsafe days 21 day pill.clear.headache E ± eye problems S ± severe leg cramps .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.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.) coitus interuptus/ withdrawal . coitus reservatus ± sex without ejaculation ± 3.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.start 5th day of mens 28day pill. Alerts on Oral Contraceptive: -in case a mother who is taking an oral contraceptive for almost long time plans to have a baby. coitus interfemora ± ³ipit´ 4. 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. Waiting time to become pregnant. Consult OB-6mos.-get short test & longest cycle from Jan ± Dec .menstruation will come out 4 ± 6 months bottle fed 2 ± 3 months disadvantage of lam ± might get pregnant Symptothermal ± combination of BBT & cervical.longest ± 11 June 26 . 99.
) Thrombophlebitis or problems in clotting factors if forgotten for one day. it will shorten duration Norplant ± has 6 match sticks ± like capsules implanted subdermally containing progesterone.parity or # of children.) HPN 4.) Check for string daily 2.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. fever.) extreme obesity 3.If mom HPN ± stop pills STAT! Adverse effect: breakthrough bleeding Contraindicated: 1.never massage injected site. DMPA ± depoproveda ± has progesterone inhibits LH ± inhibits ovulation Depomedroxy progesterone acetate ± IM q 3 months . if 1 kid only don¶t use IUD HT: 1.prevents implantation .most common complications: excessive menstrual flow and expulsion of the device (common problem) . use another method for the rest of the cycle and the start again. . 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 .it lessen sexual satisfaction . REVERSABLE .) DM 5. shorter or longer Uterine inflammation. . gives highest protection against STD ± female condom Alerts: Disadvantage: .right time to insert is after delivery or during menstruation primary indication for use of IUD . immediately take the forgotten tablet plus the tablet scheduled that day.) chain smoker 2.5 yrs ± disadvantage if keloid skin . or more days. chills S trings lost.) Regular pap smear Alerts.it gives higher protection in the prevention of STDs Diaphragm ± rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus. uterine perforation. ectopic pregnancy Condom ± latex inserted to erected penis or lubricated vagina Adv.) Monthly checkup 3.
) 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.Ht: 1. product of conception remain in uterus 4 weeks or longer. Creams Surgical Method ± BTL . jellies. (-) preg test. scanty dark brown bleeding . Abortions ± termination of pregnancy before age of viability (before 20 weeks) Spontaneous Abortion. circlage is removed. Jellies. Habitual ± 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix.) Assess for bleeding (per pad 30 ± 40cc) (wt ± 1gm =1cc) 4. No mgt just emotional support! 2. cramping.) 3.) plasma germ defect Classifications: a. High Risk Pregnancy 1. Hemorrhagic Disorders General Management 1.) Avoid sex 3.) 4. Bilateral Tubal Ligation ± can be reversed 20% chance. CS c. HT: >30 ejaculations before safe sex O ± zero sperm count.) Complete ± all products of conception are expelled. Present 2nd trimester d. Barrier ex. safe XI.) 5.) chromosomal alterations 2. signs of pregnancy cease. 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.) Save discharges ± for histopathology ± to determine if product of conception has been expelled or not First Trimester Bleeding ± abortion or eptopic A. Threatened ± pregnancy is jeopardized by bleeding and cramping but the cervix is closed Inevitable ± moderate bleeding. Foam (most effective).) CBR 2. tissue protrudes form the cervix (Cervical dilation) Types: 1.miscarriage Cause: 1.) Incomplete ± Placental and membranes retained.) 2. b. HT: avoid lifting heavy objects Vasectomy ± cut vas deferense. infection.) blighted ovum 3.) Signs of Hypovolemic shock 6. During delivery. Mgt: D&C Incompetent cervix ± abortion McDonalds procedure ± temporary circlage on cervix S/E. Missed ± fetus dies.) Ultrasound to determine integrity of sac 5. NSD Sheridan ± permanent surgery cervix.
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 pain. Double effect choose between lesser evil. dark brown.scant. The nucleus of the sperm duplicates. producing a diploid number 46 XX.abdominal pain within 3 -5 weeks of missed radiating to shoulder. Progressive degeneration of chorionic villi. period (maybe generalized or one sided) shoulder pain (indicative of intraperitoneal bleeding . .Mgt: induced labor with oxytocin or vacuum extraction 5. Hydatidiform Mole ³bunch or grapes´ or gestational trophoblastic disease. Recurs. 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 ³ snowstorm´ on sonogram Anemia Abdominal cramping Serious complications hyperthyroidism Pulmonary embolus Nursing care: Prepare D&C Do not give oxytoxic drugs Teachings: a.interstitial Unruptured Tubal rupture .) Induced Abortion ± therapeutic abortion to save life of mom. common site: tubal or ampular Dangerous site . it grows & enlarges the uterus vary rapidly. Abnormal lower implantation of placenta.sudden . Avoid pregnancy for at least one year Third Trimester Bleeding ³Placenta Anomalies´ D. Placenta Previa ± it occurs when the placenta is improperly implanted in the lower uterine segment. . vaginal bleeding that extends to diaphragm and phrenic nerve) + Cullen¶s Sign ± bluish tinged umbilicus ± signifies Nursing care: intra peritoneal bleeding Vital signs syncope (fainting) Administer IV fluids Mgt: Monitor for vaginal bleeding Surgery depending on side Monitor I & O Ovary: oophrectomy Uterus : hysterectomy Second trimester bleeding C. C. Ectopic Pregnancy ± occurs when gestation is located outside the uterine cavity.gestational anomaly of the placenta consisting of a bunch of clear vesicles.candidate for CS Sx: frank . sharp. This neoplasm is formed form the selling of the chronic villi and lost nucleus of the fertilized egg. sometimes covering the cervical os. ± with fertilization. Unilateral .missed period .
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. painful bleeding.HPN after 24 wks of pregnancy. IE.Bright red Painless bleeding Dx: Ultrasound Avoid: sex. I. 2. 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. G. solved 6 weeks post partum. 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. Abruptio Placenta ± it is the premature separation of the placenta form the implantation site. J. Outstanding Sx: dark red. Severe abdominal pain Dropping coagulation factor (a potential for DIC) Complications: Sudden fetal blood loss -placenta previa & vasa previa Nursing Care: Infuse IV. Hypertensive Disorders I. prepare to administer blood Type and crossmatch Monitor FHR Insert Foley Measure blood loss. 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. It usually occurs after the twentieth week of pregnancy. board like or rigid uterus. H. Assessment: Concealed bleeding (retroplacental) Couvelaire uterus (caused by bleeding into the myometrium)-inability of uterus to contract due to hemorrhage. .cord divides into small vessels before it enters the placenta Vasa Previa ± velamentous insertion of cord has implanted in cervical OS - F. L. Pregnancy Induced Hypertension (PIH). K.
Transissional Hypertension ± HPN between 20 ± 24 weeks III.hyperglycemia 3 degrees GTT of > 130 mg/dL .Diabetes Mellitus . Three types of pre-eclampsia 1. Provide safety.) HELLP syndrome ± hemolysis with elevated liver enzymes & low platelet count II.HPN without edema & protenuria H without EP 2.) minimal handling ± planning procedure 3.) common to mom with low socioeconomic status due to decrease intake of CHON Nursing care: P ± romote bed rest to decrease O2 demand.tongue depressor .) increase wt due to edema b.) Mild preeclampsia ± earliest sign of preeclampsia a. P.) avoid jarring bed P.1.) idiopathic or unknown common in primi due to 1st exposure to chorionic villi 2. BP decrease 2.) Severe preeclampsia Signs present: cerebral and visual disturbances. Urine output decrease 3. protenuria +3 .) common in multiple pre (twins) increase exposure to chorionic villi 3. BP 160/110 .Na ± in moderation A ± anti-hypertensive drug Hydralazine ( Apresoline) C ± convulsion.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 . antidote ± Ca gluconate 3.) BP 140/90 c.) Pre-eclampsia ± HPN with edema & protenuria or albuminuria HE P/A 3. facilitate. E ± ensure high protein intake ( 1g/kg/day) . Patella reflex absent ± 1st sigh Mg SO4 toxicity. Resp < 12 4.) Gestational hypertension . Chronic or pre-existing Hypertension ±HPN before 20 weeks not solved 6 weeks post partum. sodium excretion. quiet calm environment 2.) protenuria +1 .) dimly lit room .) Eclampsia ± with seizure! Increase BUN ± glomerular damage.prevent convulsions by nursing measures or seizure precaution 1. water immersion will cause to urinate. Cause of preeclampsia 1.prepare the following at bedside .+4 3. epigastric pain due to liver edema and oliguria usually indicates an impending convulsion.turning to side done AFTER seizure! Observe only! for safely. prevent ± Mg So4 ± CNS depressant E ± valuate physical parameters for Magnesium sulfate Magnesium SO4 Toxicity: 1.+2 2.
moderate limitation of physical activity.) Polyhydramnios 4. 2nd ± 3rd trim ± hyperglycemic 2.) Frequent infection.) preterm birth to prevent stillbirth Newborn Effect : DM 1.) hypocalcemia . for vaginal delivery. marked limitation of physical activity. Ordinary activity causes discomfort Recommendation: 1.maternal effect DM 1. decrease in insulin by 33% in 1st tri.) Insulin requirement.) anticoagulant ± heparin doesn¶t cross placenta Class I & II.) hyperinsulinism 2.poor prognosis. Recommendation: Therapeutic abortion . It will shorten 2nd stage of labor.) rest 30 minutes & after meal Class III . 50% increase insulin at 2nd ± 3rd trimester.) hyper & hypoglycemia 2.) antibiotic therapy.) macrosomia ± large gestational age ± baby delivered > 400g or 4kg 3.to prevent sub acute bacterial endocarditis 2. Heart disease Moms with RHD at childhood Class I ± no limit to physical activity Class II ± slight limitation of activity. Ordinary activity causes fatigue & discomfort. Recommendation of class I & II 1. administer dextrose 3.) sleep 10 hrs a day 2. Post partum decrease 25% due placenta out.moniliasis 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. Fetal effect 1.) Dystocia-difficult birth due to abnormalities in fetus or mom.) Hypo or hyperglycemia ± 1st trimester hypo. No valsalva maneuver Regional anesthesia! Low forcep delivery due to inability to push. Even at rest there is fatigue & discomfort.) early hospitalization by 7 months Class IV. not CS! NOT lithotomy! High semi-fowlers during delivery.good progress for vaginal delivery Class III & IV. 5.< 7mg% Sx: Calcemia tetany Trousseau sign Give calcium gluconate if decrease calcium Recommendation Therapeutic abortion If push through with pregnancy 1.
sterile bottle container ( not plastic has chem.use of IUD . Breech presentation j. If >15 ± low sperm count Best criteria. Once classical always classical b. Low segment ± bikini line type ± aesthetic use VBAC ± vaginal birth after CS INFERTILITY .truck driver 2. Placenta previa f.Manageable STERILITY .) Mom: anovulation ± no ovulation.need: sperm only . 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. Cesarean Delivery Indications: a. Abruptio placenta g.inability to achieve pregnancy. Within a year of attempting it .more practical & less complicated .) chain smoker administer: clomid ( chomephine citrate) to induce spermatogenesis Mgt: GIFT= Gamete Intra Fallopian Transfer for low sperm count Implant sperm in ampula 1. Due to increase prolactin ± hyperprolactinemia Administer.) .) occupation. antihyper prolactineuria Give mom clomid: action: to induce oogenesis or ovulation S/E: multiple pregnancy 2.) Tubal Occlusion ± tubal blockage ± Hx of PID that has scarred tubes .) primary ± no pregnancy at all 2. Intrapartal complications 1. Active herpes II d. Diabetes c.Sims Huhner test ± or post coital test.) fundal pressure . classical ± vertical insertion.irreversible Impotency ± inability to have an erection 2 types of infertility 1. CPD primary indication i. Transverse lie Procedure: a. Severe toxemia e.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. Prolapse of the cord h.XII.) Secondary ± 1st pregnancy. no more next preg test male 1st . Multiple gestation b. parlodel ( Bromocryptice Mesylate) Action.sperm motility for impotency Factors: low sperm count 1.
) forcep delivery .) episiotomy 3.2.