This action might not be possible to undo. Are you sure you want to continue?
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
Blank! Can¶t erase!
Testes ± 900 coiled (½ meter long at age 13 onwards) (Seminiferous tubules)
Epididymis ± 6 meters coiled tubules site for maturation of sperm
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
. Secretory = 15 to 26th day 3. Others: 1.III.inhibit prod of LH (hormone for ovulation) 2. 2-3 days 6. development ductile structure of breast 5. increase permeability of kidney to lactose & dextrose causing (+) sugar 5. Ovum is capable of being fertilized with in 24 ± 36 hrs after ovulation 5. Proliferative = 6 to 14th day 2. DNA ± carries genetic code 2. Phases of Menstrual Cycle: 1. Menstrual Cycle 4 phases of Menstrual Cycle 1. Sperm is viable within 48 ± 72 hrs. Reproductive cells divides by the process of meiosis (haploid) Spermatogenesis ± maturation of sperm Oogenesis ± process . Spinnbarkeit & Ferning ( billings method/ cervical) 4.inhibit motility of GIT 3. hypertrophy of myometrium 3. mammary gland development 4. Basic Knowledge on Genetics and Obstetrics 1. Age of Reproductivity ± 15 ± 44yo 8. Functions of Estrogen and Progestin * Estrogen ³Hormone of the Woman´ ± Primary function: development secondary sexual characteristic female. MenstruationMenstrual Cycle ± beginning of mens to beginning of next mens Average Menstrual Cycle ± 28 days Average Menstrual Period . Normal amount of ejaculated sperm 3 ± 5 cc.maturation of ovum Gematogenesis ± formation of 2 haploid into diploid 23 + 23 = 46 or diploid 7. 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. increase in height in female 7. 1 tsp 4. causes early closure of epiphysis of long bones 8. Chromosomes ± threadlike strands composed of hereditary material ± DNA 3. Menses = 1st to the 5th day . increase BBT 10. causes sodium retention 9. increase osteoblast activities of long bones 6. causes mood swings in moms 6. Ischemic = 27 to 28th day 4. inhibit production of FSH ( maturation of ovum) 2.3 ± 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.
Facilitate growth primary follicle to become graffian follicle (secrets large amt estrogen & contains mature ovum. Pre-ovularoty. PhaseIncreased progesterone IX. 28th day ± if no sperm in ovum ± endometrium begins to slough off to begin mens Cornix. anterior pituitary gland ± master clock of body 3. 13th day of menstruation. 15th day. 2. VII.Parts of body responsible for mens: 1. GnRH/FSHRF ± stimulates the anterior pituitary gland to release FSH Functions of FSH: 1. estrogen level is peak while the progesterone level is down. On the initial 3rd phase of menstruation . 24th day if no fertilization. hypothalamus 2. Stimulate ovaries to release estrogen 2. uterus Initial phase ± 3rd day ± decreased estrogen 13th day ± peak estrogen. marks ovulation day. hormone for ovulation VI. increase progesterone I. post mens phase. Capacitation. Proliferative Phase ± proliferation of tissue or follicular phase. mood swing GnRF/LHRF stimulates the ant pit gland to release LH. Secretory phaseLutheal Phase Postovulatory Premenstrual Phase V.) Change in BBT. decrease progesterone 14th day ± Increase estrogen.) III. Functions of LH: 1. graafian follicle starts to degenerate yellowish known as corpus luteum (secrets large amount of progesterone) VIII. pearly white Phonones-vibration of head of sperm to determine location of ovum Sperm should penetrate corona radiata and zona pellocida. -phase of increase estrogen.where sperm is deposited Sperm. long tail.small head.) Mittelschmerz ± slight abdominal pain on L or RQ of abdomen. these stimulates the hypothalamus to release GnRF on LHRF 1. this level stimulates the hypothalamus to release GnRH or FSHRF II. (13th day-decreased progesterone) LH stimulates ovaries to release progesterone 2. ovaries 4. after ovulation day. the estrogen level is decreased. increase progesterone 15th day ± Decrease estrogen. 11. Follicular Phase ± causing irregularities of mens Postmenstrual Phase Preovulatory Phase ± phase increase estrogen IV. 14th day estrogen level is increased while the progesterone level is increased causing rupture of graffian follicle on process of ovulation.ability of sperm to release proteolytic enzyme to penetrate corona radiata and zona pellocida. corpus luteum degenerate ( whitish ± corpus albicans) X. Stages of Sexual Responses (EPOR) Initial responses: .
Adhesion 3. May last 2 ± 10 sec. Common complication fetal limb defect. 3. Plateau Phase ± (accelerated V/S) ± increasing & sustained tension nearing orgasm. Orgasm ± (involuntary spasm throughout body. sex flush. nipple erection) ± erotic stimuli cause increase sexual tension. moderate increase in HR. Done early in pregnancy. Blastocyst ± enlarging cells that forms a cavity that later becomes the embryo. Lasts 30 seconds ± 3 minutes. 4. 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.Vasocongestion ± congestion of blood vessels Myotonia ± increase muscle tension 1. Fertilization B. C. Resolution ± (v/s return to normal. Zygote. Chorionic Villi.fertilized ovum. Implantation/ Nidation. slight vaginal spotting . RR. 4 days free floating & multiplication c. Blastocyst ± covering of blastocys that later becomes placenta & trophoblast d.2 months to birth.if with fertilization ± corpus luteum continues to function & become source of estrogen & progesterone while placenta is not developed. Invasion C. immeasurable peak of sexual experience. placenta previa ± implantation at low side of uterus Signs of implantation: 1. genitals return to pre-excitement phase) Refractory Period ± the only period present in males. Ex missing digits/toes. slight pain 2. Stages of Fetal Growth and Development 3-4 days travel of zygote ± mitotic cell division begins *Pre-embryonic Stage a. peak v/s) involuntary release of sexual tension with physiologic or psychologic release.BP. Apposition 2.most affected are is pelvic area. 3 processes of Implantation 1. lasts minutes to hours. Lifespan of zygote ± from fertilization to 2 months b. Morula ± mulberry-like ball with 16 ± 50 cells. 2. wherein he cannot be restimulated for about 10-15 minutes A. 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. Excitement Phase ± (sign present in both sexes.occurs after fertilization 7 ± 10 days. . Fetus.
20 ± 21´. clear. odor mousy/musty. Cytotrophoblast ± inner layer or langhans layer ± protects fetus against syphilis 24 wks/6 months ± life span of langhans layer increase. Before 24 weeks critical. *Function of Amniotic Fluid: 1. Short cord: abruptio placenta or inverted uterus. increased amt of fluid oligohydramnios.+ ruptured amniotic fluid) C. fluid is tested for: 1. maintains temp 4. slightly alkaline. 15 ± 55cm.urine. 1. Amnioscopy ± direct visualization or exam to an intact fetal membrane.GIT malformation TEF/TEA. Genetic screening.maternal serum alpha feto-protein test (MSAFP) ± 1st trimester 2. Synsitiotrophoblast ± synsitial layer ± responsible production of hormone 1.E. Chorion ± where placenta is developed Lecithin Sphingomyelin L/S Ratio.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 . Paper turns yellow.decrease amt of fluid ± kidney disease Diagnostic Tests for Amniotic Fluid A.pre term labor Important factor to consider for amniocentesis.FUNIS. facilitates musculo-skeletal development 3. hydramnios. Amniotic Fluid ± bag of H2O. whitish grey. help in delivery process normal amt of amniotic fluid ± 500 to 1000cc polyhydramnios. Long cord:cord coil or cord prolapse b. 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. B.determine if amniotic fluid has ruptured or not (blue paper turns green/grey . Amniocentesis empty bladder before performing the procedure. Purpose ± obtain a sample of amniotic fluid by inserting a needle through the abdomen into the amniotic sac.needle insertion site Aspiration of yellowish amniotic fluid ± jaundice baby Greenish ± meconium A. Amnion ± inner most layer a. might get infected syphilis F. Nitrazine Paper Test ± diff amniotic fluid & urine. Fern Test. cushions fetus against sudden blows or trauma 2. Paper turns blue green/gray-(+) rupture of amn fluid. Umbilical Cord. with crystallized forming pattern. prevent cord compression 5.
If mom hypoglycemic.for calcium Thymus ± development of immunity Liver ± lining of upper RT & GIT * Mesoderm ± development of heart. 5. CNS develops ± dizziness of mom due to hypoglycemic effect Food of brain ± glucose complex CHO ± pregnant womans food (potato) Second Month 1. Kidneys functional 2. placenta developed 2.carries waste products. diffusion more rapid from higher to lower. combination of chorionic villi + deciduas basalis. Sex organ formed 4.Brain & heart development GIT& resp Tract ± remains as single tube 1. glucose transport is facilitated. Meconium is formed Third Month 1. skin and senses. nails.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 . fetus hypoglycemic Excretory System. Size: 500g or ½ kg -1 inch thick & 8´ diameter Functions of Placenta: a. Simple diffusion GIT ± transport center. 1. hair. 4. Buds of milk teeth appear . Corpus luteum ± source of estrogen & progesterone of infant ± life span ± end of 2nd month 3. Human placental Lactogen or sommamommamotropin Hormone ± for mammary gland development. 2. All vital organs formed. kidneys and repro organ * Ectoderm ± development of brain. Liver of mom detoxifies fetus. musculoskeletal system. It serves as a protective barrier against some microorganisms ± HIV.artery . Has a diabetogenic effect ± serves as insulin antagonist Relaxin Hormone. Fetal heart tone begins ± heart is the oldest part of the body 2.Placenta ± (Secundines) Greek ± pancake. mucus membrane or anus & mouth First trimester: 1st month .causes softening joints & bones estrogen progestin 3. Respiratory System ± beginning of lung function after birth of baby. Circulating system ± achieved by selective osmosis Endocrine System ± produces hormones y y y y y 6. Human Chorionic Gonadrophin ± maintains corpus luteum alive.
2. 3. 16. 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. Fetal heart tone heard ± Doppler ± 10 ± 12 weeks Sex is distinguishable Second Trimester: FOCUS ± length of fetus 1. fetal alcohol withdrawal syndrome char by microcephaly Smoking ± low birth rate Caffeine ± low birth rate Cocaine ± low birth rate. 4.3. 2. hyperbilirubenia or jaundice Iodides ± enlargement of thyroid or goiter Thalidomides ± Amelia or pocomelia. D. 4. 18. 2. Terratogens. the exposure to such may cause damage to the fetus A.20 weeks primi. 2. inhibit growth of long bone Vitamin K ± hemolysis (destr of RBC). Drugs: Streptomycin ± anti TB & or Quinine (anti malaria) ± damage to 8th cranial nerve ± poor hearing & deafness Tetracycline ± staining tooth enamel.any drug. 1. C. 3. 2. TORCH (Terratogenic) Infections ± viruses . Quickening. Third trimester: Period of most rapid growth.18 wks ± multi fetal heart tone heard with or without instrument Sixth Month eyelids open wrinkled skin vernix caseosa present 1. 3. 18 ± 20 weeks buds of permanent teeth appear Fifth Month lanugo covers body actively swallows amniotic fluid 19 ± 25 cm fetus. absence of extremities Steroids ± cleft lip or palate Lithium ± congenital malformation Alcohol ± lowered weight (vasoconstriction on mom). 5. virus or irradiation. abruption placenta B. E. Fourth Month lanugo begins to appear fetal heart tone heard fetoscope. 3.1st fetal movement. 1.
Vaccine is terratogenic C ± cytomegalo virus H ± herpes simplex virus VI. y Oral Iron supplements (ferrous sulfate 0. liver due to ferridin content.Assessment reveals: y Pallor. Hepa A or infectious heap ± oral/ fecal (hand washing) Hepa B.saluyot. TORCH: Toxoplasmosis. Z tract. horseradish. Feces of cat go to raw vegetables or meat O ± others. influenza like findings. give IM.5 ± 14g/dL Criteria 1st and 3rd trimester. black stool.if improperly administered.5% pathologic anemia if lower Pathogenic Anemia . increase heart workload. Herpes simples virus. Hgb should not be < 11g/dL 2nd trimester ± Hct should not <32% Hgb Shdn't < 10. 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. constipation y Monitor for hemorrhage .easy fatigability.. enlarged lymph nodes. Physiological Adaptation of the Mother to Pregnancy A.pathologic anemia if lower HCT should not be 33%. epistaxis ± due to hyperemia of nasal membrane palpitation. slight hypertrophy of ventricles. Don¶t get pregnant for 3 months. T ± toxoplasmosis ± mom takes care of cats. . Other. These infections are often characterized by vague.3 g. ampalaya y Parenteral Iron ( Imferon) ± severe anemia. In some chases the infection may go unnoticed in the pregnant woman yet have devastating effects on the fetus. Physiologic Anemia ± pseudo anemia of pregnant women Normal Values Hct 32 ± 42% Hgb 10. rashes and lesions. hematoma. Rubella. It affects toughly 20% of pregnant women. green leafy vegetable-alugbati.CHARACTERISTICS: group of infections caused by organisms that can cross the placenta or ascend through birth canal and adversely affect fetal growth and development. Cardiovascular System ± increase blood volume of mom (plasma blood) 30 ± 50% = 1500 cc of blood . 3 times a day) empty stomach 1 hr before meals or 2 hrs after. Systemic Changes 1.iron deficiency anemia is the most common hematological disorder. constipation y Slowed capillary refill y Concave fingernails (late sign of progressive anemia) due to chronic physio hypoxia Nursing Care: y Nutritional instruction ± kangkong. after delivery. and jaundice (hepatic involvement). Cytomegalo virus. mom will be given rubella vaccine. malunggay.
watermelon. Respiratory system ± common problem SOB due to enlarged uterus & increase O2 demand Position. apple with skin. elevate legs above hip level.use elastic bandage ± lower to upper Vulbar varicosities. F&E imbalance ± primary med mgt ± replace fluids.small frequent feeding. Monitor I&O constipation ± progesterone resp for constipation. to relieve. Varicosities ± pressure of uterus .lateral expansion of lungs or side lying position.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. avoid wearing knee high socks . pineapple. mango.) 5. Nausea afternoon . avoid 3 full meals.increase fibrinogen . malungay. Except guava ± has pectin that¶s constipating ± veg ± petchy.small freq feeding. Increase fluid intake. suha. cantaloupe.exercise -mineral oil ± excretion of fat soluble vitamins * Flatulence ± avoid gas forming food ± cabbage * Heartburn ± or pyrosis ± reflux of stomach content to esophagus . Vomiting in preg ± emesisgravida. avoid fatty & spicy food.) 6.fruits ± papaya.) 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. 2.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. Eat dry crackers or dry CHO diet 30 minutes before arising bed.position ± side lying with pillow under hips or modified knee chest position Thrombophlebitis ± presence of thrombus at inflamed blood vessel .painful. Metabolic alkalosis.) 3. y Gastrointestinal ± 1st trimester change Morning Sickness ± nausea & vomiting due to increase HCG.) 2. protamine sulfate Avoid aspirin! Might aggravate bleeding.use support stockings.increase clotting factor .) 4. 3. . proper body mechanical increase salivation ± ptyalsim ± mgt mouthwash . pressure on gravid uterus. increase fiber diet .pregnant mom hyperfibrinogenemia . sips of milk.
treat dad also to prevent reinfection 2. seafood-tahong (mussels).condifoma acuminata due to papilloma virus Mgt: cauterization . cotrimaxole. head of fish. fungal infection. yogurt. 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. 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. canesten Gonorrhea -Thick purulent discharge Vaginal warts. oversex. PROGESTERONE ± hormone responsible for operculum PREGNANT ± acidic to alkaline change to protect bacterial growth (vaginitis) Problems Related to the Change of Vaginal Environment: a.*Hemorrhoids ± pressure of gravid uterus. over fatigue. Vit D for increased Ca absorption dorsiflexion B. 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). Cheese. resp for leucorrhea OPERCULUM ± mucus plug to seal out bacteria. 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. Color ± white cheese like patches adheres to walls of vagina. lobster. crab. no alcohol ± has antibuse effect VAGINAL DOUCHE ± IQ H2O : 1 tbsp white vinegar b. Carcinogenic drug so don¶t give at 1st trimester 1. mousy odor discharge ESTROGEN ± hormone. chills. Ca & phosphorous imbalance(#1 cause while pregnant). 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. Signs & Symptoms: Management ± antifungal ± Nistatin. Moniliasis or candidiasis due to candida albecans. brocolli. Mgt. hot sitz bath for comfort 4. sardines with bones. Dilis. genshan violet.
Breast Changes ± increase hormones. umbilicus is protruding 3. Developmental task is to accept biological facts of pregnancy Focus: bodily changes of preg. colostrums at 3rd trimester Breast self exam.2. Brown pinkish line. Subjective B.change of consistency of cervix Urinary freq Chadwick¶s.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 . ambivalence.trans vaginal ultrasound. mammography ± 35 to 49 yrs once every 1 to 2 yrs 50 yrs and above ± 1 x a yr 6. nutrition .blue violet discoloration of vagina Fatigue Hegar's.there is calcium Presumptive Probable Breast changes Goodel's. surprise.symphisis pubis to umbilicus 4.linea nigra. denial ± sign of maladaptation to pregnancy. Ovaries ± rested during pregnancy 7. Skin Changes ± brown pigmentation nose chin. color of areola & nipple pre colostrums present by 6 weeks. 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. use coconut oil. Objective C. Probable ± signs observed by the members of health team. Psychological Adaptation to Pregnancy (Emotional response of mom ±Reva Rubin theory) First Trimester: No tanginal signs & sx. Empty bladder . cheeks ± chloasma melasma due to increased melanocytes. Positive Signs ± undeniable signs confirmed by the use of instrument.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. Presumptive ± s/s felt and observed by the mother but does not confirm positive diagnosis of pregnancy . Signs & symptoms of Pregnancy A.
Home base mom¶s record. Third Trimester: .) Home preg kit ± do it yourself Baseline Data: V/S esp.5 ± 3 lbs 10 ± 12 lbs 10 ± 12 lbs (.mom has personal identification on appearance of baby Development task: prepare of birth & parenting of child. 5.Second Trimester ± tangible S&Sx. Pre-Natal Visit: 1. mom identifies fetus as a separate entity ± due to presence of quickening.# of pregnancy b. non judgmental Occupation ± financial condition or occupational hazards.# of viable pregnancy Viability ± the ability of the fetus to live outside the uterus at the earliest possible gestational age. education background ± level knowledge 3. BP. Sex ( pseudocyesis or false pregnancy on men & women) Couvade syndrome ± dad experiences what mom goes through ± lihi) Address.5 ± 1lb/month) (4 lbs/month) (1 lb/wk) (4 lbs/ month) ( 1lb/wk) 4. fantasy. (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. Personal data ± name. Gravida.) Elisa test ± test for preg detects beta subunit of HCG as early as 7 ± 10days 3. age of viability . 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 .) urine exam to detect HCG at 40 ± 100th day. Most common fear ± let mom listen to FHT to allay fear Lamaze classes VII. Para . monitor wt. 60 ± 70 day peak HCG. Developmental task ± accept growing fetus as baby to be nurtured. civil status. 2. Diagnosis of Pregnancy 1. Obstetrical Data: nullipara ± no pregnancy a.best to get urine exam. 6 weeks after LMP. culture & beliefs with respect. age (high risk < 18 & >35 yrs old) record to determine high risk ± HBMR. religion. 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 2.20 ± 24 wks Term 37 ± 42 wks. Health teaching: growth & development of fetus. HT: responsible parenthood µbaby¶s Layette´ ± best time to do shopping.
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. 04 +9 +7 10 / 32 / 04 . 3 months ± above sym pub 5 months ± level of umbilicus 9 months ± below zyphoid 10 months ± level of 8 months due to lightening 4. 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. 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. 2nd ½ of preg tetanus immunizations ± prevents tetanus neonatum -mom with complete 3 doses DPT young age considered as TT1 & 2. Haases rule ± to determine length of the fetus in cm. square @ month 2nd ½ of preg. 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. Bartholomew¶s Rule ± to determine age of gestation by proper location of fundus at abdominal cavity. Formula: 1st ½ of preg .1 add 1 month to month 11/31/04 EDD 2. Begin TT3 TT1 ± any time during pregnancy TT2 ± 4 wks after TT1 ± 3 yrs protection . Important Estimates: GP GTPAL 4 2 4 11 1 1 GP GTPAL 6 4 6 2 2 15 1.
universal precaution EXT OS of cervix ± site for getting specimen Site for cervical cancer Pap Smear ± cervical cancer .normal Class IIA ± acytology but no evidence of malignancy B ± suggestive of infl. position. . incompetent cervix 3rd ± placental anomalies S ± sudden gush of fluid ± PROM (premature rupture of membrane) prone to inf. presenting part. an estimate of the size.use palm! Warm palm. 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. fetal back & fetal heart tone . Physical Examination: A. and number of fetuses. Prep mom: 1.composed of squamous columnar tissue Result: Class I . ectopic pre/2nd ± H mole.cancer extends to vagina 3 ± pelvis metastasis 4 ± affection to bladder & rectum 7. Procedure: Empty bladder Position of mom-supine with knee flex (dorsal recumbent ± to relax abdominal muscles) 6. E ± edema to upper ext. fetal presentation lie. abortion. empty bladder 2. Examine teeth: sign of infection Danger signs of Pregnancy C . degree of descent.TT3 ± 6 months after TT2 ± 5 yrs protection TT4 ± 1 yr after TT3 ± 10 yrs protection TT5 ± yr after TT4 ± lifetime protection 5. 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 . (preeclampsia) Pelvic Examination ± internal exam 1.chills/ fever . Leopold¶s Maneuver Purpose: is done to determine the attitude.
the head is extended. When the brow is on the same side as the back. often require further testing. movement and firmness of the part to determine presentation 2nd Maneuver: with both hands moving down. with both hands palpate upper abdomen and fundus. biographical profile (BPP) B.) more then 1 hour to reach 10 movements b. With two hands. Cardiff count to 10 method ± one method currently available (1) Begin at the same time each day (usually in the morning.fetal distress) c. Uterine soufflé ± maternal H rate 3rd Maneuver: using the right hand. less vigorous Movement alarm signals .< 3 FMs in 12 hours 4. Daily Fetal Movement Counting (DFMC) ±begin 27 weeks Mom.) less then 10 movements in 12 hours(non-reactive. To determine attitude ± relationship of fetus to 1 another. 4th Maneuver: the Examiner changes the position by facing the patient¶s feet.) movement are becoming weaker. Assess whether the presenting part is engaged in the pelvis )Alert : if the head is engaged it will not be movable). Nonstress test ± to determine the response of the fetal heart rate to activity Indication ± pregnancies at risk for placental insufficiency Postmaturity a. Examples: nonstress test (NST). shape.) warning signs noted during DFMC c.) maternal history of smoking. When the brow is on the same side as the small parts. identify the back of the fetus ( to hear fetal heart sound) where the ball of the stethoscope is placed to determine FHT. assess the descent of the presenting part by locating the cephalic prominence or brow. diabetes b.begin after meal . Assess size.1st maneuver: place patient in supine position with knees slightly flexed. inadequate nutrition Procedure: . Get V/S(before 2nd maneuver) PR to diff fundic soufflé (FHR) & uterine soufflé.) pregnancy induced hypertension (PIH).) longer time to reach 10 FMs than on previous days d. grasp the symphis pubis part using thumb and fingers.breakfast a. put towel under head and right hip.) warning signs should be reported to healthcare provider immediately. after breakfast) and count each fetal movement. To determine degree of engagement. Attitude ± relationship of fetus to a part ± or degree of flexion Full flexion ± when the chin touches the chest 8.Assessment of Fetal Well-BeingA. the head will be flexed and vertex presenting. 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.
(BPP) or contraction stress test (CST) 9. lasting at least 15 seconds in a 10 to 20 minute period as a result of FM 3.Begin increase in second sources for the nutrients requiring for trimester during pregnancy .utilization of nutrients activity level . ii. Good variability ± normal irregularity of cardiac rhythm representing a balanced interaction between the parasympathetic (decreases FHR) and sympathetic (increase FHR) nervous system. 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 . ultrasound transducer over abdominal site where most distinct fetal heart sounds are detected 3. Requires further evaluation with another NST.Development of structures . 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. Nonreactive result 1. Stated criteria for a reactive result are not met 2.No more than 30% fat . complex carbohydrates . Vegetarian mom ± decrease CHON ± needs Vit B12 ± cyanocobalamin ± formation of folic acid ± needed for cell DNA & RBC formation.Variety of foods representing foods . external monitor is applied to document fetal activity. over wt ± candidate for HPN.Done within 30 minutes wherein the mother is in semi-fowler¶s position (w/ fetal monitor). 2. noted as an uneven line on the rhythm strip.CHON x4. result indicates a healthy fetus with an intact nervous system i. tocotransducer over fundus to detect uterine contractions and fetal movements (FMs) 2. Attach external noninvasive fetal monitors 1. 4. Health teachings a. Pregnant teenagers ± low compliance to heath regimen.Foods of high nutrient value such Essential to supply energy for to maintain ideal body weight as protein. Could be indicative of a compromised fetus. vegetables. DM 3. (Decrease folic acid ± spina bifida/open neural tube defect) How many Kcal CHO x4. Extremes in wt ± underweight. Nutrition ± do nutritional assessment ± daily food intake High risk moms: 1.Growth of fetus . biophysical profile. mother activates the ³mark button´ on the electronic monitor when she feels fetal movement. Low socio ± economic status 4.Use weight ± gain pattern . fruits) . Baseline FHR between 120 and 160 beats per minute 2. such as a CST Result: Noncreative Nonstress Not Good Reactive Responsive is Real Good Interpretation of results reactive result 1.protein sparing so it can be used .increased metabolic rate and meet energy requirement to (whole grains. At least two accelerations of the FHR of at least 15 beats per minute.
Maintenance of mineralization of maternal bones and teeth . seafood Iron increases should reflect .dark green leafy vegetables.Begin supplementation at 30. 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 .Current research is : Demonstrating an association between adequate calcium intake and the prevention of pregnancy induce hypertension Iron Essential for . legumes . red meat.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 . poultry.liver.Expansion of blood volume and red blood cells formation . cheese.nuts.dairy products : milk. amniotic fluid.whole grains.iron from food sources is more readily absorbed when served with foods high in vit C .enriched.Growth and development of fetal skeleton and tooth buds .Failure to meet caloric requirements can lead to ketosis as fat and protein are used for energy. butter. cheese.Maternal tissue growth including uterus and breasts .green leafy vegetables . strawberries.Development of essential pregnancy structures . ketosis has been associated with fetal damage. nuts . cantaloupe. poultry. margarine.inadequate iron intake results in maternal effects ± anemia depletion of iron Calcium increases should reflect: .Eggs. egg yolk . whole grain cereals and breads . and tissue growth.Ca fortified foods such as orange juice . as an indication of adequacy of calorie intake.vitamin C sources: citrus fruits & juices.mg/day in second trimester.Fetal tissue growth .canned salmon & sardines w/ bones .Vitamin D sources: fortified milk.Dried beans. liver. eggs .70 mg/day of vitamin C which enhances iron absorption . .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 . broccoli or cabbage.1200 mg/day representing an increase of 50% above prepregnancy daily requirement. since diet alone is unable to meet pregnancy requirement . dried fruits . Protein Essential for: .1600 mg/day is recommended for the adolescent. ice cream. . egg yolk. milk .Lean meat. potatoes . tofu . fish. yogurt.60 ± 120 mg/day along with copper and zinc supplementation for women who have low hemoglobin values prior to pregnancy or who have iron deficiency anemia. fish .required for pregnancy including placenta. lentils. .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 .
Whole grains.Zinc Essential for * the formation of enzymes * maybe important in the prevention of congenital malformation of the fetus.Sexual Activity a.iodine . lean beef.) should be done in private place c.) changes in sexual desire of mom during preg. Hard to excrete. Folate Essential for .eggs. Folic Acid.DNA synthesis and cell formation. Folacin. 2.air embolism Changes in sexual desire: a.2 mg/day 2. decreased energy and appetite. meats .) 2nd trimester ± increased desire due to increase estrogen that enhances lubrication c.formation of red blood cells and prevention of anemia . nuts Increases should reflect . abruption placenta Additional Requirements Minerals . sidelying or mom on top d. legumes. broccoli. 15mcg/day representing an increase of 3 mg/day over prepreganant daily requirements.Magnesium .whole grains.5 mg/day 1.shell fish .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.Selenium Vitamins E Thiamine Riborlavin Pyridoxine ( B6) B12 Niacin stores. legumes. veal .fetal effects decreased availability of oxygen thereby affecting fetal growth * iron deficiency anemia is the most common nutritional disorder of pregnancy. Zinc increases should reflect . Vit stored in body.) avoided 6 weeks prior to EDD e.) 1st tri ± decrease desire ± due to bodily changes b. may play a role in the prevention of neutral tube defects (spina bifida). cardiac stress especially labor and birth .liver. incompetent cervix . peanuts 400 mcg/day representing an increase of more then 2 times the daily prepregnant requirement. abortion. milk. .) mom placed in comfy pos. Taking it not needed ± fat soluble vitamins.) 3rd trimester ± decreased desire Contraindication in sex: 1. cheese . vaginal spotting 1st trimester ± threatened abortion 2nd trimester± placenta previa 2.dark green leafy vegetables. 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.liver.) avoid blowing or air during cunnilingus f. kidney.6 mg/day 2.) should be done in moderation b.
Ferdinand Lamaze req. Robert Bradley ± advocated active participation of husband at delivery process. exhale mouth 3. Squatting ± strengthen muscles of perineum.) quiet environment 3.) Must be individualized Walking ± best exercise 3. helping them achieved a satisfying and enjoying childbirth experience. Conscious relaxation 2. Based on imitation of nature.) darkened rm 2. Four extremities on floor Kegel Exercise ± strengthen pulococcygeal muscles . Lamaze: Dr. labor & birth & care of newborn is an impt turning pt in woman¶s life cycle . Psychoprophylaxis ± prevention of pain 1. Effleurage ± gentle circular massage over abdominal to relieve pain 4. Kitzinger method ± preg.) relaxation tech 4.strengthen chest muscles pelvic rocking/pelvic tilt.) Done in moderation. Childbirth Preparation: Overall goal: to prepare parents physically and psychologically while promoting wellness behavior that can be used by parents and family thus. disciple. release 10x or muscle contraction Abdominal Exercise ± strengthens muscles of abdominal ± done as if blowing candle 4. Husband is coach Features: 1. Features: 1. preterm labor 4.3. Grantly Dick Read Method ± fear leads to tension while tension leads to pain b.) birthing chair ± bed convertible to chair ± semifowlers . Different Methods of delivery: 1. imaging ± sensate focus 5. 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. premature rupture of membrane Exercise ± to strengthen muscles used during delivery process principles of exercise 1. conditioning & concentration. Cleansing breathe ± inhale nose. Bradley Method ± Dr. 2.as if hold urine.) closed eye & appearance of sleep 2.flow with contraction than struggle with contraction c. Psychosexual 1. Psychophysical 1. Increase circulation to perineum.exercise ± relieves low back pain & maintain good posture * arch back ± standing or kneeling. a.
) < 4¶9´ tall 2. complete flexion.) Posterior fontanel or lambda ± triangular shape. address.25cm . dark. will always contract & expel its content) ± contraction action 2. comfy room.) birthing bed ± dorsal recumbent pos squatting ± relives low back pain during labor pain leboyers ± warm. Passageway Mom 1. IX. smallest AP occipitofrontal 12cm partial flexion occipitomental ± 13.5 cm.( > 5 cm ± hydrocephalus). quiet. b. soft music. Hypothalamus produces oxytocin 3. diamond shape.) 5. Intrapartal Notes ± inside ER A.bitemporal 8 cm 2. Admitting the laboring Mother: Personal Data: name.) uterine stretch theory ( any hallow organ stretched. baby gets warm bath.) progesterone theory ± before labor.) Anteroposterior diameter suboccipitobregmatic 9. weight Obstetrical Data: gravida # preg. b. age.) oxytocin theory ± post pit gland releases oxytocin. 4. Birth under H20 ± bathtub ± labor & delivery ± warm water.5 cm hyper extension submentobragmatic-face presentation 2.) coronal suture ± connect parietal & frontal bone (crown) 3. After delivery. At 36 wks degenerates (leading to contraction ± onset labor).occiput T ± temporal P ± parietal 2 x Measurement fetal head: 1.) prostaglandin theory ± stimulation of arachidonic acid ± prostaglandin. bimastoid 7cm smallest transverse Sutures ± intermembranous spaces that allow molding.) 4. 3 x 4 cm.) < 18 years old 3. etc Baseline Data: v/s esppecially BP.) theory of aging placenta ± life span of placenta 42 wks.2.) Underwent pelvic dislocation . para. Basic knowledge in Intrapartum.) sagittal suture ± connects 2 parietal bones ( sagitna) 2. 1 Theories of the Onset of Labor 1.Pelvic Exams B.sinciput E ± ethmoid O ± occuputal . transverse diameter ± 9. Closes ± 2 ± 3 months. decrease progesterone will stimulate contractions & labor 5.) 3. ± 22 ± 24 wks Physical Exams. The 4 P¶s of labor 1. Fetal head ± is the largest presenting part ± common presenting part ± ¼ of its length. 1. 12 ± 18 months after birth. Passenger a.) 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: 1.2.) Anterior fontanel ± bregma. Bones ± 6 bones S ± sphenoid F ± frontal .viable preg.close 2.contraction 4.biparietal ± largest transverse . 1 x 1 cm.
2 weeks prior to EDD * Engagement.urinary freq. Ischial tuberosity ± approximated with use of fist ± 8 cm & above. Obstetrical conjugate ± smallest AP diameter. Measurement: 11. True conjugate/conjugate vera ± measure between the anterior surface of the sacral promontory and superior margin of the symphysis pubis. Bloody Show ± pinkish vaginal discharge ± blood & leukorrhea 7. Gynecoid ± round. Lightening ± setting of presenting part into pelvic brim . Ripening of the Cervix ± butter soft 5. (DC ± 11. Android ± heart shape ³male pelvis´. AP diameter wider transverse narrow 4. Braxton Hicks Contractions ± painless irregular contractions 3. Measurement: 11. will be used for delivery.nesting instinct. Timing: frequency. duration.anterior part pointed. Past Experience d. Voluntary bearing down efforts c.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.shooting pain radiating to the legs . Pelvis at 10 cm or more. Increase Activity of the Mother. 1. Save energy.12. Diagonal Conjugate ± measure between sacral promontory and inferior margin of the symphysis pubis. Check FHT . Preparation c. Anthropoid ± oval. Characteristics: wave like d. transverse ± wider b. decreased body wt ± 1.Pelvis 4 main pelvic types 1. Rupture of Membranes ± rupture of water. Cultural Interpretation b. Tuberoischi Diameter ± transverse diameter of the pelvic outlet. Support System Pre-eminent Signs of Labor S&Sx: . oval shape. Psyche/Person ± psychological stress when the mother is fighting the labor experience a.setting of presenting part into pelvic inlet 2. 3. Pelvis 2 hip bones ± 2 innominate bones 3 Parts of 2 Innominate Bones Ileum ± lateral side of hips . Power ± the force acting to expel the fetus and placenta ± myometrium ± powers of labor a.5 cm basis in getting true conjugate. posterior part shallow 3. Involuntary Contractions b. intensity 4. deeper most suitable (normal female pelvis) for pregnancy 2.iliac crest ± flaring superior border forming prominence of hips Ischium ± inferior portion . Platypelloid ± flat AP diameter ± narrow.5 cm .5 cm=true conjugate) 2. wide.0 cm 3. ape like pelvis. Increase epinephrine 4.5 ± 3 lbs 6.
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 . 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.Premature Rupture of Membrane ( PROM) . Count pulsation of cord for FHT 4.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. especially if fetal distress is noted Cord Prolapse ± a complication when the umbilical cord falls or is washed through the cervix into the vagina. Use % in unit of measurement Dilation ± widening of cervix. 2. Slip cord away from presenting part 3. Nursing Interventions in Each Stage of Labor 2 segments of the uterus 1. Danger signs: PROM Presenting part has not yet engaged Fetal distress Protruding cord form vagina Nursing care: 1.fundus 2. 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. Duration of Labor Primipara ± 14 hrs & not more than 20 hrs Multipara ± 8 hrs & not > 14 hrs Effacement ± softening & thinning of cervix. Unit used is cm. upper uterine .
cervical dilation and effacement. Encourage to void q 2 ± 3 hrs ± full bladder inhibit contractions 3. Breathing ± chest breathing Active Phase: Assessment: Dilations 4 -8 cm Intensity: moderate Mom. Station ± landmark used: ischial spine . etc.1. 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.1. 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. can communicate Frequency: every 5 ± 10 min Intensity mild Nursing Care: 1. apprehensive.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. First Stage: onset of true contractions to full dilation and effacement of cervix. Latent Phase: Assessment: Dilations: 0 ± 3 cm mom ± excited. 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.1 station = presenting part 1cm above ischial spine if (-) floating . fetal monitor. Longitudinal Lie ( Parallel) cephalic Vertex ± complete flexion Face Brow Poor Flexion Chin . Encourage walking .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.
let mom rest.will cause aspiration 3.)Sims position/side lying 12 ± 18 inch ± ht enema tubing . c. Shoulder presentation. most painful ROP ± squatting pos on mom ROT ROA Breech. RMT. RSP Chin / Mento LMA. RSA.Breech - Complete Breech ± thigh breast on abdomen. breast lie on thigh Incomplete Breech ± thigh rest on abdominal Frank ± legs extend to head Footling ± single. RMA. Variety: Occipito ± LOA left occipito ant (most common and favorable position)± side of maternal pelvis LOP ± left occipito posterior LOP ± most common mal position.)Prevent infection c. 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. LADT. notify MD -preeclampsia Health teachings 1. LMT. If BP increase .put stet above umbilicus Shoulder/acromniodorso LADA. LSP.)NPO ± GIT stops function during labor if with food.2. LMP.) Ok to shower 2. Position ± relationship of the fatal presenting part to specific quadrant of the mother¶s pelvis.)Enema administer during labor a. Transverse Lie (Perpendicular) or Perpendicular lie. RST. double Kneeling b.)To cleanse bowel b. RMP.use sacrum . if same 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 . LADP. RADA LSA ± left sacro anterior LST.strength of contraction Contraction ± vasoconstriction Increase BP.
Mechanisms of labor 1. Extension 6. placenta has 15 ± 28 cotyledons . less pain easy to repair. 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. complete dilation and effacement to birth. Inlet ± AP diameter narrow. slow to heal -use local or pudendal anesthesia. Descent 3. identification of baby. supports uterus during pregnancy Linea Terminales diagonal imaginary line from the sacrum to the symphysis pubis that divides the false and true pelvis.)To prevent laceration 2. False pelvis ± above the pelvic inlet. shorten 2nd stage of labor. Cavity Two Major Divisions of Pelvis 1. Episiotomy ± median ± less bleeding.to prevent laceration. Flexion 4. fast to heal. Internal Rotation 5. check cord if coiled.< 48 hours only ± vaginal pack Bolus of Ptocin can lead to hypotension. Lengthening of the cord 3. (Support head & remove secretion. Third Stage: birth to expulsion of Placenta -placental stage Placenta delivered from 3-10 minutes Signs of placental separation 1. Ironing the perineum ± to prevent laceration Modified Ritgens maneuver ± place towel at perineum 1.) mecomium stain amnion fluid 3. Pull shoulder down & up. transverse diameter wider 2. hard to repair.) fetal thrushing ± hyperactive fetus due to lack O2 2. Second Stage: fetal stage. widen vaginal canal. True pelvis ± below the pelvic inlet 2. Fundus rises ± becomes firm & globular ³ Calkins sign´ 2.Check FHT after adm enema Normal FHT= 120-160 Signs of fetal distress1.) <120 & >160 2. Check time. Engagement 2. External rotation 7. Nursing Care: To prevent puerperal sepsis . Expulsion Three parts of Pelvis ± 1. possible to reach rectum ( urethroanal fistula) Mediolateral ± more bleeding & pain.) Will facilitate complete flexion & extension.
Check fundus (if relaxed. 1 gram=1cc e.MD administer sedative valium. Assist MD for episiorapy 11. Nsg care for placenta: 4. Monitor hpn (or give oxytocin IV) 9. 2. Fourth Stage: the first 1-2 hours after delivery of placenta ± recovery stage.dema E .intense excessive contractions resulting to ineffective pushing . Count pad & saturation 4. Flat on bed 12. 2nd hr q 30 minutes. Placement of the Fundus c. give clear liquid-tea. Check placement of fundus at level of umbilicus. ginger ale.) hypotonic ± secondary uterine inertia.) Straight rooming in baby: 24hrs with mom. Maternal Observations ± body system stabilizes b. If fundus above umbilicus.edness E. Let mom sleep to regain energy. Check perineum for lacerations 10.) Check lochia a. Perineum ± R .3.slow irregular contraction resulting to ineffective pushing.) hypertonic or primary uterine inertia .) Partial rooming in: baby in morning .cchemosis D ± ischarges A ± approximation of blood loss. massage uterus) 6. Check completeness of placenta. at night nursery Complications of Labor Dystocia ± difficult labor related to: Mechanical factor ± due to uterine inertia ± sluggishness of contraction 1. 5. . Chills-due dehydration. Fully soaked pad : 30 ± 40 cc weigh pad./diazepam ± muscle relaxant 2.) Empty bladder to prevent uterine atony 2. Lochia d. Give oxytocin. 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. Monitor v/s q 15 for 1 hr. Administer methergine IM (Methylergonovine Maleate) ³Ergotrate derivatives 8. Bonding ± interaction between mother and newborn ± rooming in types 1. Blanket. deviation of fundus 1. clear gelatin. Check bp 7.
Trial Labor ± measurement of head & pelvis falls on borderline. nose.) hypovolemic shock d. etc. 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.) 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.Prolonged labor ± normal length of labor in primi 14 ± 20 hrs Multi 10 -14 hrs > 14 hrs in multi & > 20 hrs in primi .)Large baby 3. hypovolemic shock if with bleeding.maternal effect ± exhaustion.) Improper use of oxytocin (IV drip) Sx: a.nsg care: monitor contractions and FHR Precipitate Labor .) sudden pain b. premature contractions q 10 min . extensive lacerations. Factors leading to inversion of uterus 1. caput succedaneum or cephal hematoma .) 1.) profuse bleeding c.bleeding to all portions of the body ± eyes. MD will push uterus back inside or not hysterectomy.Boundary bet upper/lower uterine segment BANDL¶S pathologic ring ± suprapubic depression a.)Previous classical CS 2.labor of < 3 hrs.) hurrying of placental delivery 3. Fetal effect ± fetal distress. chest pain & frothy sputum prepare: suctioning end stage: DIC disseminated intravascular coagopathy. profuse bleeding. primi 14 ± 20 Preterm Labor ± labor after 20 ± 37 weeks) ( abortion <20 weeks) Sx: 1.) TAHBSO Physiologic retraction ring . Mom given 6 hrs of labor Multi: 8 ± 14.) ineffective fundal pressure Uterine Rupture Causes: 1.) short cord 2.
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. position prone . Physiologic Changes a.YUTOPAR. Vaginal and Pelvic Floor c. birth pain: 1. avoid sex 3. Genital tract a.1. Postpartal Period 5th stage of labor after 24hrs :Normal increase WBC up to 30. Monitor: FHT > 180 bpm Maternal BP .2. dilation 2-3 cm Home Mgt: 1.the first few minutes after delivery is the most critical period in mothers because the increased in plasma volume return to its normal state and thus adding to the workload of the heart.halts preterm contractions. If cervix is closed 2 ± 3 cm. To return to Normal and Facilitate healing A.a medium for bacterial growth.Yutopar Hcl) 150mg incorporated 500cc Dextrose piggyback. empty bladder 4. Cervix ± cervical opening b.early ambulation Principles underlying puerperium 1. consult MD if symptoms persist Hosp: 1. Hyperfibrinogenia . This is critical especially to gravidocardiac mothers. X.000 cumm Puerperium ± covers 1st 6 wks post partum Involution ± return of repro organ to its non pregnant state.prone to thrombus formation . effacement of 60 ± 80% 3. Systemic Changes 1. Uterus ± return to normal 6 ± 8 wks.<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 .D&C after.(puerperal sepsis). dilation saved by administer Tocolytic agents. drink 3 -4 glasses of water ± full bladder inhibits contractions 5. 2. Cardiovascular System . complete bed rest 2.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.
Mgt: 1.urinary retention with overflow 4. Colon: Constipation ± due NPO. Alba ± créme white 10 ± 21 days very decreased amt dysuria . Letting go ± interdependent phase ± 7 days & above. . moderate amt 2. 1. cold compress ± to prevent bleeding 3.) 1st degree laceration ± affects vaginal skin & mucus membrane.) 3.when perineum has healed II.stimulate bladder 3. hot sitz bath. c.) Insert family planting method common post partum blues/ baby blues present 4 ± 5 days 50-80% moms ± overwhelming feeling of depression characterized by crying. Hemorrhage ± bleeding of > 500cc CS ± 600 ± 800 cc normal NSD 500 cc Early postpartum hemorrhage± bleeding within 1st 24 hrs. cold compress for immediate pain after 24 hrs. III. ± let mom cry ± therapeutic. wbc. Taking in phase ± dependent phase (1st three days) mom ± passive.alternate warm & cold compress . Provide Emotional Support ± Reva Rubia Psychological Responses: a. 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. Nursing Care: . Complications: hypovolemic shock. Lochia-bld. Serosa ± pink to brown 4 ± 9th day. mefenamic acid d. Perineal area ± painful ± episiotomy site ± sims pos. can make decisions HT: 1. Prevent complications 1. deciduas.proper hygiene b. cant make decisions. Nsd & Cs with lochia.) 4. Urinary tract: Bladder ± freq in urination after delivery.2. massage uterus until contracted cold compress modified trendelenberg IV fast drip/ oxytocin IV drip I. Ruba ± red 1st 3 days present. activity is to tell child birth experiences.inability to sleep & lack of appetite. despondence.) 2. Mom is active. musty/mousy. microorganism. fear of bearing down 5.redefines new roles may extend until child grows.) Care of newborn 2. Baggy or relaxed uterus & profuse bleeding ± uterine atony. limited amt 3.urine collection . Mom . Taking hold phase ± dependent to independent phase (4 to 7 days). not compress sex.
) cold compress every 30 minutes with rest period of 30 minutes for 24 hrs 2. Natural Method ± the only method accepted by the Catholic Church .too much manipulation . 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.) exogenous ± from outside 1.cryoprecipitate or fresh frozen plasma II. Acreta ± attached placenta to myometrium.) determine one¶s own beliefs 1st 2.bleeding to any part of body . Hypofibrinogen.sources of infection 1. Inflammation ± calor (heat). Motivate the use of Family Planning 1. saline. D&C except placenta increta. rubor (red).) shave 3.) supportive care ± CBR. between & resulting.hysterectomy if with abruption placenta mgt: BT.large baby . VITC. 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.mgt episiorapy DIC ± Disseminated Intravascular Coagulopathy. Fowlers ± to facilitate drainage & localize infection oxytocin & antibiotic IV. scraping & suturing Infection.)endogenous ± from within body 2.) never advice a permanent method of planning 3. pos. cold compress.degree of laceration .) anaerobic streptococci ± most common .assess perineum for laceration .failure to coagulate.) unhealthy sexual practices General signs of inflammation: 1. hydration. . . paracetamol.) incision on site.) method of choice is an individuals choice.pudendal anesthesia Mgt: 1. Endometriosis ± inflammation of endometrial lining Sx: Abdominal tenderness. TSB. percreta. dolor (pain) tumor(swelling) 2.from members health team 2.Well contracted uterus + bleeding = laceration . purulent discharges 3. Late Postpartum hemorrhage ± bleeding after 24 hrs ± retained placental fragments Mgt: D&C or manual extraction of fragments & massaging of uterus. fever Gen mgt: 1.
start 5th day of mens 28day pill.3 months. Best method Social Method ± 1.clear. . Alerts on Oral Contraceptive: -in case a mother who is taking an oral contraceptive for almost long time plans to have a baby.-get short test & longest cycle from Jan ± Dec .) coitus interuptus/ withdrawal .get before arising in bed LAM ± lactation amenorrheal method ± hormone that inhibits ovulation is prolactin.headache E ± eye problems S ± severe leg cramps .18 8 Dec 33 -11 22 unsafe days 21 day pill. elastic ± long spinnbarkeit Basal Body Temperature 13th day temp goes down before ovulation ± no sex .menstruation will come out 4 ± 6 months bottle fed 2 ± 3 months disadvantage of lam ± might get pregnant Symptothermal ± combination of BBT & cervical.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. coitus reservatus ± sex without ejaculation ± 3. Consult OB-6mos. Signs of hypertension Immediate Discontinuation A ± abdominal pain C ± chest pain H .9% effective. stretchable. calendar method OVULATION ±count minus 14 days before next mens (14 days before next mens) Origoknause formula ± . Waiting time to become pregnant. 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. breast feeding.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. watery. .least effective method 2.Billings / Cervical mucus± test spinnbarkeit & ferning (estrogen) . 99. coitus interfemora ± ³ipit´ 4.monitor cycle for 1 year .shortest ± 18 .longest ± 11 June 26 .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.
) Check for string daily 2. ectopic pregnancy Condom ± latex inserted to erected penis or lubricated vagina Adv.) HPN 4. it will shorten duration Norplant ± has 6 match sticks ± like capsules implanted subdermally containing progesterone.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. use another method for the rest of the cycle and the start again.prevents implantation . fever. if 1 kid only don¶t use IUD HT: 1.as soon as removed ± can become pregnant Mechanism and Chemical Barriers Intrauterine Device (IUD) Action: prevents implantation ± affects motility of sperm & ovum .) Monthly checkup 3.) chain smoker 2. or more days. immediately take the forgotten tablet plus the tablet scheduled that day.If mom HPN ± stop pills STAT! Adverse effect: breakthrough bleeding Contraindicated: 1. REVERSABLE . . chills S trings lost.it lessen sexual satisfaction .parity or # of children.most common complications: excessive menstrual flow and expulsion of the device (common problem) . If forgotten for two consecutive days.) Regular pap smear Alerts.never massage injected site.right time to insert is after delivery or during menstruation primary indication for use of IUD .5 yrs ± disadvantage if keloid skin . shorter or longer Uterine inflammation. gives highest protection against STD ± female condom Alerts: Disadvantage: . .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.) Thrombophlebitis or problems in clotting factors if forgotten for one day.) extreme obesity 3. DMPA ± depoproveda ± has progesterone inhibits LH ± inhibits ovulation Depomedroxy progesterone acetate ± IM q 3 months .) DM 5.
High Risk Pregnancy 1. Mgt: D&C Incompetent cervix ± abortion McDonalds procedure ± temporary circlage on cervix S/E.) Incomplete ± Placental and membranes retained. infection.) plasma germ defect Classifications: a. safe XI. 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. Missed ± fetus dies.miscarriage Cause: 1. Jellies. Foam (most effective). product of conception remain in uterus 4 weeks or longer.) Complete ± all products of conception are expelled. jellies. signs of pregnancy cease. scanty dark brown bleeding . Abortions ± termination of pregnancy before age of viability (before 20 weeks) Spontaneous Abortion.) 5. NSD Sheridan ± permanent surgery cervix.) Signs of Hypovolemic shock 6.) Ultrasound to determine integrity of sac 5. Threatened ± pregnancy is jeopardized by bleeding and cramping but the cervix is closed Inevitable ± moderate bleeding.Ht: 1. HT: >30 ejaculations before safe sex O ± zero sperm count. Hemorrhagic Disorders General Management 1. CS c. cramping. Habitual ± 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix. During delivery. Bilateral Tubal Ligation ± can be reversed 20% chance.) 4. circlage is removed. Barrier ex.) Save discharges ± for histopathology ± to determine if product of conception has been expelled or not First Trimester Bleeding ± abortion or eptopic A.) 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. Creams Surgical Method ± BTL . No mgt just emotional support! 2. (-) preg test.) 2. Present 2nd trimester d. b.) CBR 2.) Avoid sex 3.) Assess for bleeding (per pad 30 ± 40cc) (wt ± 1gm =1cc) 4.) 3.) blighted ovum 3. HT: avoid lifting heavy objects Vasectomy ± cut vas deferense.) chromosomal alterations 2. tissue protrudes form the cervix (Cervical dilation) Types: 1.
severe pain.candidate for CS Sx: frank . Recurs.gestational anomaly of the placenta consisting of a bunch of clear vesicles. The nucleus of the sperm duplicates. 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. Abnormal lower implantation of placenta. . Hydatidiform Mole ³bunch or grapes´ or gestational trophoblastic disease. sometimes covering the cervical os.) Induced Abortion ± therapeutic abortion to save life of mom.abdominal pain within 3 -5 weeks of missed radiating to shoulder. it grows & enlarges the uterus vary rapidly. 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.scant.missed period . Double effect choose between lesser evil.interstitial Unruptured Tubal rupture . Avoid pregnancy for at least one year Third Trimester Bleeding ³Placenta Anomalies´ D. common site: tubal or ampular Dangerous site . . 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.Mgt: induced labor with oxytocin or vacuum extraction 5. Placenta Previa ± it occurs when the placenta is improperly implanted in the lower uterine segment. producing a diploid number 46 XX. sharp. Progressive degeneration of chorionic villi. Unilateral . C. ± with fertilization. Ectopic Pregnancy ± occurs when gestation is located outside the uterine cavity.sudden . period (maybe generalized or one sided) shoulder pain (indicative of intraperitoneal bleeding . This neoplasm is formed form the selling of the chronic villi and lost nucleus of the fertilized egg. dark brown.
Bright red Painless bleeding Dx: Ultrasound Avoid: sex. 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. J. painful bleeding.HPN after 24 wks of pregnancy. . 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. K. board like or rigid uterus. IE. 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. 2. L.cord divides into small vessels before it enters the placenta Vasa Previa ± velamentous insertion of cord has implanted in cervical OS - F. I. 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. Assessment: Concealed bleeding (retroplacental) Couvelaire uterus (caused by bleeding into the myometrium)-inability of uterus to contract due to hemorrhage. Hypertensive Disorders I. solved 6 weeks post partum. Abruptio Placenta ± it is the premature separation of the placenta form the implantation site. G. H. 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. prepare to administer blood Type and crossmatch Monitor FHR Insert Foley Measure blood loss. Pregnancy Induced Hypertension (PIH).
facilitate. Transissional Hypertension ± HPN between 20 ± 24 weeks III.) HELLP syndrome ± hemolysis with elevated liver enzymes & low platelet count II.HPN without edema & protenuria H without EP 2.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 . Patella reflex absent ± 1st sigh Mg SO4 toxicity. Chronic or pre-existing Hypertension ±HPN before 20 weeks not solved 6 weeks post partum. BP decrease 2. Resp < 12 4. sodium excretion.Diabetes Mellitus .+2 2. epigastric pain due to liver edema and oliguria usually indicates an impending convulsion. prevent ± Mg So4 ± CNS depressant E ± valuate physical parameters for Magnesium sulfate Magnesium SO4 Toxicity: 1.1. E ± ensure high protein intake ( 1g/kg/day) .prepare the following at bedside .) Gestational hypertension . Three types of pre-eclampsia 1. Provide safety. antidote ± Ca gluconate 3. P. quiet calm environment 2.turning to side done AFTER seizure! Observe only! for safely. protenuria +3 .+4 3.) common in multiple pre (twins) increase exposure to chorionic villi 3.hyperglycemia 3 degrees GTT of > 130 mg/dL .) BP 140/90 c. water immersion will cause to urinate.) dimly lit room . BP 160/110 .) avoid jarring bed P.) Pre-eclampsia ± HPN with edema & protenuria or albuminuria HE P/A 3.) Mild preeclampsia ± earliest sign of preeclampsia a.Na ± in moderation A ± anti-hypertensive drug Hydralazine ( Apresoline) C ± convulsion. Urine output decrease 3.prevent convulsions by nursing measures or seizure precaution 1.tongue depressor .) minimal handling ± planning procedure 3.) Eclampsia ± with seizure! Increase BUN ± glomerular damage.) idiopathic or unknown common in primi due to 1st exposure to chorionic villi 2.) protenuria +1 . Cause of preeclampsia 1.) increase wt due to edema b.) Severe preeclampsia Signs present: cerebral and visual disturbances.) common to mom with low socioeconomic status due to decrease intake of CHON Nursing care: P ± romote bed rest to decrease O2 demand.
) sleep 10 hrs a day 2.) Polyhydramnios 4.) early hospitalization by 7 months Class IV.) antibiotic therapy. Ordinary activity causes discomfort Recommendation: 1.) rest 30 minutes & after meal Class III . Even at rest there is fatigue & discomfort. not CS! NOT lithotomy! High semi-fowlers during delivery.< 7mg% Sx: Calcemia tetany Trousseau sign Give calcium gluconate if decrease calcium Recommendation Therapeutic abortion If push through with pregnancy 1.good progress for vaginal delivery Class III & IV. Recommendation: Therapeutic abortion .maternal effect DM 1.) anticoagulant ± heparin doesn¶t cross placenta Class I & II.) preterm birth to prevent stillbirth Newborn Effect : DM 1.moderate limitation of physical activity.) Frequent infection. Heart disease Moms with RHD at childhood Class I ± no limit to physical activity Class II ± slight limitation of activity. decrease in insulin by 33% in 1st tri.) Insulin requirement.) Hypo or hyperglycemia ± 1st trimester hypo.moniliasis 3. marked limitation of physical activity. Fetal effect 1.) macrosomia ± large gestational age ± baby delivered > 400g or 4kg 3.) hyperinsulinism 2. 2nd ± 3rd trim ± hyperglycemic 2.poor prognosis.to prevent sub acute bacterial endocarditis 2. for vaginal delivery. Ordinary activity causes fatigue & discomfort. Recommendation of class I & II 1. It will shorten 2nd stage of labor.) hyper & hypoglycemia 2. administer dextrose 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. 5.) hypocalcemia . Post partum decrease 25% due placenta out.) Dystocia-difficult birth due to abnormalities in fetus or mom. No valsalva maneuver Regional anesthesia! Low forcep delivery due to inability to push. 50% increase insulin at 2nd ± 3rd trimester.
Breech presentation j.) Mom: anovulation ± no ovulation.more practical & less complicated .) . Once classical always classical b. classical ± vertical insertion.) Tubal Occlusion ± tubal blockage ± Hx of PID that has scarred tubes .inability to achieve pregnancy. no more next preg test male 1st .) occupation. Cesarean Delivery Indications: a.sterile bottle container ( not plastic has chem.Sims Huhner test ± or post coital test.need: sperm only . Placenta previa f.use of IUD .) Secondary ± 1st pregnancy. Abruptio placenta g. Transverse lie Procedure: a.sperm motility for impotency Factors: low sperm count 1. CPD primary indication i. If >15 ± low sperm count Best criteria. Multiple gestation b. Low segment ± bikini line type ± aesthetic use VBAC ± vaginal birth after CS INFERTILITY . antihyper prolactineuria Give mom clomid: action: to induce oogenesis or ovulation S/E: multiple pregnancy 2.) primary ± no pregnancy at all 2.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. Diabetes c. 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. Due to increase prolactin ± hyperprolactinemia Administer. Prolapse of the cord h.) fundal pressure . Within a year of attempting it . Active herpes II d.Manageable STERILITY .) chain smoker administer: clomid ( chomephine citrate) to induce spermatogenesis Mgt: GIFT= Gamete Intra Fallopian Transfer for low sperm count Implant sperm in ampula 1.XII. Intrapartal complications 1. Severe toxemia e.irreversible Impotency ± inability to have an erection 2 types of infertility 1.truck driver 2. parlodel ( Bromocryptice Mesylate) Action.
2.) forcep delivery .) episiotomy 3.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue listening from where you left off, or restart the preview.