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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
Sperm is viable within 48 ± 72 hrs. hypertrophy of myometrium 3. Reproductive cells divides by the process of meiosis (haploid) Spermatogenesis ± maturation of sperm Oogenesis ± process . increase BBT 10. MenstruationMenstrual Cycle ± beginning of mens to beginning of next mens Average Menstrual Cycle ± 28 days Average Menstrual Period . 1 tsp 4.inhibit motility of GIT 3. development ductile structure of breast 5. DNA ± carries genetic code 2. causes sodium retention 9. 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. Secretory = 15 to 26th day 3. Phases of Menstrual Cycle: 1. increase osteoblast activities of long bones 6. increase permeability of kidney to lactose & dextrose causing (+) sugar 5. Basic Knowledge on Genetics and Obstetrics 1. Ovum is capable of being fertilized with in 24 ± 36 hrs after ovulation 5. 2-3 days 6. Normal amount of ejaculated sperm 3 ± 5 cc. Functions of Estrogen and Progestin * Estrogen ³Hormone of the Woman´ ± Primary function: development secondary sexual characteristic female.inhibit prod of LH (hormone for ovulation) 2.. causes early closure of epiphysis of long bones 8. causes mood swings in moms 6. Spinnbarkeit & Ferning ( billings method/ cervical) 4.maturation of ovum Gematogenesis ± formation of 2 haploid into diploid 23 + 23 = 46 or diploid 7. Proliferative = 6 to 14th day 2. Others: 1.III. mammary gland development 4. Menses = 1st to the 5th day . 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. Menstrual Cycle 4 phases of Menstrual Cycle 1. increase in height in female 7. Ischemic = 27 to 28th day 4. Chromosomes ± threadlike strands composed of hereditary material ± DNA 3. Age of Reproductivity ± 15 ± 44yo 8.
decrease progesterone 14th day ± Increase estrogen. increase progesterone 15th day ± Decrease estrogen. ovaries 4. marks ovulation day. 11. anterior pituitary gland ± master clock of body 3. (13th day-decreased progesterone) LH stimulates ovaries to release progesterone 2.Parts of body responsible for mens: 1. after ovulation day. Pre-ovularoty. 15th day. pearly white Phonones-vibration of head of sperm to determine location of ovum Sperm should penetrate corona radiata and zona pellocida. 28th day ± if no sperm in ovum ± endometrium begins to slough off to begin mens Cornix. Secretory phaseLutheal Phase Postovulatory Premenstrual Phase V. 14th day estrogen level is increased while the progesterone level is increased causing rupture of graffian follicle on process of ovulation. 13th day of menstruation. Stimulate ovaries to release estrogen 2. post mens phase. On the initial 3rd phase of menstruation . these stimulates the hypothalamus to release GnRF on LHRF 1.) Change in BBT. long tail. -phase of increase estrogen. Capacitation. estrogen level is peak while the progesterone level is down. Proliferative Phase ± proliferation of tissue or follicular phase. Follicular Phase ± causing irregularities of mens Postmenstrual Phase Preovulatory Phase ± phase increase estrogen IV. GnRH/FSHRF ± stimulates the anterior pituitary gland to release FSH Functions of FSH: 1.where sperm is deposited Sperm. Functions of LH: 1.ability of sperm to release proteolytic enzyme to penetrate corona radiata and zona pellocida. uterus Initial phase ± 3rd day ± decreased estrogen 13th day ± peak estrogen. this level stimulates the hypothalamus to release GnRH or FSHRF II. hypothalamus 2. 2. Stages of Sexual Responses (EPOR) Initial responses: . PhaseIncreased progesterone IX. VII.small head.) III. the estrogen level is decreased. corpus luteum degenerate ( whitish ± corpus albicans) X. mood swing GnRF/LHRF stimulates the ant pit gland to release LH.) Mittelschmerz ± slight abdominal pain on L or RQ of abdomen. increase progesterone I. hormone for ovulation VI. Facilitate growth primary follicle to become graffian follicle (secrets large amt estrogen & contains mature ovum. 24th day if no fertilization. graafian follicle starts to degenerate yellowish known as corpus luteum (secrets large amount of progesterone) VIII.
Fetus. Lifespan of zygote ± from fertilization to 2 months b. 2. Implantation/ Nidation. lasts minutes to hours. 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. May last 2 ± 10 sec. 3. Blastocyst ± covering of blastocys that later becomes placenta & trophoblast d.most affected are is pelvic area. Fertilization B. 4. Common complication fetal limb defect. slight pain 2. Blastocyst ± enlarging cells that forms a cavity that later becomes the embryo.Vasocongestion ± congestion of blood vessels Myotonia ± increase muscle tension 1. Zygote.2 months to birth. Plateau Phase ± (accelerated V/S) ± increasing & sustained tension nearing orgasm.fertilized ovum.if with fertilization ± corpus luteum continues to function & become source of estrogen & progesterone while placenta is not developed. Chorionic Villi. Done early in pregnancy. Orgasm ± (involuntary spasm throughout body. sex flush. wherein he cannot be restimulated for about 10-15 minutes A. moderate increase in HR. immeasurable peak of sexual experience. Invasion C. C.10 ± 11th day. Resolution ± (v/s return to normal. Adhesion 3. Apposition 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. Excitement Phase ± (sign present in both sexes.BP. 3 processes of Implantation 1. nipple erection) ± erotic stimuli cause increase sexual tension. genitals return to pre-excitement phase) Refractory Period ± the only period present in males. Morula ± mulberry-like ball with 16 ± 50 cells. Ex missing digits/toes.occurs after fertilization 7 ± 10 days. . placenta previa ± implantation at low side of uterus Signs of implantation: 1. Lasts 30 seconds ± 3 minutes. RR. 4 days free floating & multiplication c. 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. slight vaginal spotting .
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 .pre term labor Important factor to consider for amniocentesis.needle insertion site Aspiration of yellowish amniotic fluid ± jaundice baby Greenish ± meconium A. help in delivery process normal amt of amniotic fluid ± 500 to 1000cc polyhydramnios. Paper turns blue green/gray-(+) rupture of amn fluid. hydramnios.E. clear.GIT malformation TEF/TEA. Nitrazine Paper Test ± diff amniotic fluid & urine. Purpose ± obtain a sample of amniotic fluid by inserting a needle through the abdomen into the amniotic sac. Short cord: abruptio placenta or inverted uterus. might get infected syphilis F. increased amt of fluid oligohydramnios. with crystallized forming pattern.decrease amt of fluid ± kidney disease Diagnostic Tests for Amniotic Fluid A. prevent cord compression 5. 20 ± 21´.FUNIS. slightly alkaline. Chorion ± where placenta is developed Lecithin Sphingomyelin L/S Ratio.+ ruptured amniotic fluid) C. *Function of Amniotic Fluid: 1. Synsitiotrophoblast ± synsitial layer ± responsible production of hormone 1. Before 24 weeks critical. Fern Test. 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. fluid is tested for: 1. cushions fetus against sudden blows or trauma 2. Cytotrophoblast ± inner layer or langhans layer ± protects fetus against syphilis 24 wks/6 months ± life span of langhans layer increase.maternal serum alpha feto-protein test (MSAFP) ± 1st trimester 2. maintains temp 4. facilitates musculo-skeletal development 3. Long cord:cord coil or cord prolapse b. 1. Amnioscopy ± direct visualization or exam to an intact fetal membrane. 15 ± 55cm. odor mousy/musty. whitish grey. Umbilical Cord. B. Amniocentesis empty bladder before performing the procedure. Genetic screening. Amniotic Fluid ± bag of H2O.determine if amniotic fluid has ruptured or not (blue paper turns green/grey . Paper turns yellow.urine. Amnion ± inner most layer a.
Meconium is formed Third Month 1. Kidneys functional 2. placenta developed 2. Human placental Lactogen or sommamommamotropin Hormone ± for mammary gland development. mucus membrane or anus & mouth First trimester: 1st month . musculoskeletal system. nails.causes softening joints & bones estrogen progestin 3. CNS develops ± dizziness of mom due to hypoglycemic effect Food of brain ± glucose complex CHO ± pregnant womans food (potato) Second Month 1.artery . kidneys and repro organ * Ectoderm ± development of brain.Placenta ± (Secundines) Greek ± pancake. glucose transport is facilitated. Human Chorionic Gonadrophin ± maintains corpus luteum alive. hair. 5. Corpus luteum ± source of estrogen & progesterone of infant ± life span ± end of 2nd month 3. Simple diffusion GIT ± transport center. Circulating system ± achieved by selective osmosis Endocrine System ± produces hormones y y y y y 6.Brain & heart development GIT& resp Tract ± remains as single tube 1. If mom hypoglycemic. All vital organs formed. Respiratory System ± beginning of lung function after birth of baby. 1. Has a diabetogenic effect ± serves as insulin antagonist Relaxin Hormone. Buds of milk teeth appear . Liver of mom detoxifies fetus.for calcium Thymus ± development of immunity Liver ± lining of upper RT & GIT * Mesoderm ± development of heart. 2. Sex organ formed 4.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 . diffusion more rapid from higher to lower.carries waste products. fetus hypoglycemic Excretory System. Fetal heart tone begins ± heart is the oldest part of the body 2. 4. combination of chorionic villi + deciduas basalis. Size: 500g or ½ kg -1 inch thick & 8´ diameter Functions of Placenta: a. skin and senses. It serves as a protective barrier against some microorganisms ± HIV.
D. 16. Quickening. abruption placenta B. 2. 18. the exposure to such may cause damage to the fetus A. fetal alcohol withdrawal syndrome char by microcephaly Smoking ± low birth rate Caffeine ± low birth rate Cocaine ± low birth rate. Third trimester: Period of most rapid growth.20 weeks primi. 3. 4. 3. 2. 3. 2. absence of extremities Steroids ± cleft lip or palate Lithium ± congenital malformation Alcohol ± lowered weight (vasoconstriction on mom).3. 1. 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. Drugs: Streptomycin ± anti TB & or Quinine (anti malaria) ± damage to 8th cranial nerve ± poor hearing & deafness Tetracycline ± staining tooth enamel. 18 ± 20 weeks buds of permanent teeth appear Fifth Month lanugo covers body actively swallows amniotic fluid 19 ± 25 cm fetus.any drug. virus or irradiation. Fetal heart tone heard ± Doppler ± 10 ± 12 weeks Sex is distinguishable Second Trimester: FOCUS ± length of fetus 1. C. hyperbilirubenia or jaundice Iodides ± enlargement of thyroid or goiter Thalidomides ± Amelia or pocomelia.18 wks ± multi fetal heart tone heard with or without instrument Sixth Month eyelids open wrinkled skin vernix caseosa present 1. E. 2. 1. 4. inhibit growth of long bone Vitamin K ± hemolysis (destr of RBC). TORCH (Terratogenic) Infections ± viruses .1st fetal movement. Fourth Month lanugo begins to appear fetal heart tone heard fetoscope. 3. 5. 2. Terratogens.
5% pathologic anemia if lower Pathogenic Anemia . Hepa A or infectious heap ± oral/ fecal (hand washing) Hepa B.if improperly administered. constipation y Slowed capillary refill y Concave fingernails (late sign of progressive anemia) due to chronic physio hypoxia Nursing Care: y Nutritional instruction ± kangkong. In some chases the infection may go unnoticed in the pregnant woman yet have devastating effects on the fetus.CHARACTERISTICS: group of infections caused by organisms that can cross the placenta or ascend through birth canal and adversely affect fetal growth and development. T ± toxoplasmosis ± mom takes care of cats. after delivery. . constipation y Monitor for hemorrhage . liver due to ferridin content.3 g. epistaxis ± due to hyperemia of nasal membrane palpitation. 3 times a day) empty stomach 1 hr before meals or 2 hrs after. 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. Rubella. Cardiovascular System ± increase blood volume of mom (plasma blood) 30 ± 50% = 1500 cc of blood . It affects toughly 20% of pregnant women. Hgb should not be < 11g/dL 2nd trimester ± Hct should not <32% Hgb Shdn't < 10. give IM. black stool. green leafy vegetable-alugbati. Physiologic Anemia ± pseudo anemia of pregnant women Normal Values Hct 32 ± 42% Hgb 10. Other.5 ± 14g/dL Criteria 1st and 3rd trimester. malunggay. These infections are often characterized by vague.saluyot. enlarged lymph nodes.pathologic anemia if lower HCT should not be 33%. Herpes simples virus. Don¶t get pregnant for 3 months. hematoma. and jaundice (hepatic involvement). Cytomegalo virus. horseradish. Systemic Changes 1. slight hypertrophy of ventricles. mom will be given rubella vaccine. Z tract.iron deficiency anemia is the most common hematological disorder. influenza like findings. Vaccine is terratogenic C ± cytomegalo virus H ± herpes simplex virus VI..Assessment reveals: y Pallor. rashes and lesions. ampalaya y Parenteral Iron ( Imferon) ± severe anemia. Feces of cat go to raw vegetables or meat O ± others. increase heart workload. TORCH: Toxoplasmosis. y Oral Iron supplements (ferrous sulfate 0. Physiological Adaptation of the Mother to Pregnancy A.easy fatigability.
malungay.) 5.lateral expansion of lungs or side lying position.) 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.small freq feeding. . cantaloupe. pineapple. Increase fluid intake. 3.) 4. protamine sulfate Avoid aspirin! Might aggravate bleeding. Vomiting in preg ± emesisgravida.) 3.exercise -mineral oil ± excretion of fat soluble vitamins * Flatulence ± avoid gas forming food ± cabbage * Heartburn ± or pyrosis ± reflux of stomach content to esophagus .fruits ± papaya. Nausea afternoon . pressure on gravid uterus.use support stockings.small frequent feeding.) 2.) 6. elevate legs above hip level.increase clotting factor . Metabolic alkalosis. mango. sips of milk. Respiratory system ± common problem SOB due to enlarged uterus & increase O2 demand Position.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.use elastic bandage ± lower to upper Vulbar varicosities. Eat dry crackers or dry CHO diet 30 minutes before arising bed. avoid 3 full meals. Varicosities ± pressure of uterus . y Gastrointestinal ± 1st trimester change Morning Sickness ± nausea & vomiting due to increase HCG. Monitor I&O constipation ± progesterone resp for constipation.position ± side lying with pillow under hips or modified knee chest position Thrombophlebitis ± presence of thrombus at inflamed blood vessel . proper body mechanical increase salivation ± ptyalsim ± mgt mouthwash . avoid fatty & spicy food.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. 2. watermelon.increase fibrinogen . to relieve.pregnant mom hyperfibrinogenemia . F&E imbalance ± primary med mgt ± replace fluids. suha. Except guava ± has pectin that¶s constipating ± veg ± petchy.painful. apple with skin. increase fiber diet . avoid wearing knee high socks .
brocolli. mousy odor discharge ESTROGEN ± hormone.condifoma acuminata due to papilloma virus Mgt: cauterization . resp for leucorrhea OPERCULUM ± mucus plug to seal out bacteria. Ca & phosphorous imbalance(#1 cause while pregnant). sardines with bones. Vit D for increased Ca absorption dorsiflexion B. treat dad also to prevent reinfection 2. yogurt. crab. cotrimaxole. 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. 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). Carcinogenic drug so don¶t give at 1st trimester 1. seafood-tahong (mussels). oversex. Moniliasis or candidiasis due to candida albecans. Mgt.*Hemorrhoids ± pressure of gravid uterus. 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. Cheese. 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. genshan violet. hot sitz bath for comfort 4. Dilis. PROGESTERONE ± hormone responsible for operculum PREGNANT ± acidic to alkaline change to protect bacterial growth (vaginitis) Problems Related to the Change of Vaginal Environment: a. 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. over fatigue. fungal infection. chills. lobster. head of fish. canesten Gonorrhea -Thick purulent discharge Vaginal warts. Color ± white cheese like patches adheres to walls of vagina. no alcohol ± has antibuse effect VAGINAL DOUCHE ± IQ H2O : 1 tbsp white vinegar b.
Probable ± signs observed by the members of health team. Positive Signs ± undeniable signs confirmed by the use of instrument.2.linea nigra. colostrums at 3rd trimester Breast self exam. color of areola & nipple pre colostrums present by 6 weeks.blue violet discoloration of vagina Fatigue Hegar's. Presumptive ± s/s felt and observed by the mother but does not confirm positive diagnosis of pregnancy .there is calcium Presumptive Probable Breast changes Goodel's. Subjective B. mammography ± 35 to 49 yrs once every 1 to 2 yrs 50 yrs and above ± 1 x a yr 6. surprise.trans vaginal ultrasound. Breast Changes ± increase hormones.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. cheeks ± chloasma melasma due to increased melanocytes. Abdominal Changes ± striae gravidarium (stretch marks) due enlarging uterus-destruction of sub Q tissue ± avoid scratching. Ovaries ± rested during pregnancy 7.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 . Ballotment sign of myoma * + HCG ± sign of H mole . Objective C. ambivalence. denial ± sign of maladaptation to pregnancy.change of consistency of cervix Urinary freq Chadwick¶s. Skin Changes ± brown pigmentation nose chin. Empty bladder . umbilicus is protruding 3. use coconut oil.7 days after mens ±± supine with pillow at back quadrant B ± upper outer ± common site of cancer Test to determine breast cancer: 1. Psychological Adaptation to Pregnancy (Emotional response of mom ±Reva Rubin theory) First Trimester: No tanginal signs & sx. Developmental task is to accept biological facts of pregnancy Focus: bodily changes of preg. nutrition . Brown pinkish line. Signs & symptoms of Pregnancy A.symphisis pubis to umbilicus 4.
religion. 2.5 ± 3 lbs 10 ± 12 lbs 10 ± 12 lbs (. mom identifies fetus as a separate entity ± due to presence of quickening.mom has personal identification on appearance of baby Development task: prepare of birth & parenting of child.) Home preg kit ± do it yourself Baseline Data: V/S esp. Sex ( pseudocyesis or false pregnancy on men & women) Couvade syndrome ± dad experiences what mom goes through ± lihi) Address. 5.# of pregnancy b. Most common fear ± let mom listen to FHT to allay fear Lamaze classes VII. education background ± level knowledge 3. Para . 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 ± 1lb/month) (4 lbs/month) (1 lb/wk) (4 lbs/ month) ( 1lb/wk) 4. Gravida.Second Trimester ± tangible S&Sx. 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 . Diagnosis of Pregnancy 1. Developmental task ± accept growing fetus as baby to be nurtured. civil status.) urine exam to detect HCG at 40 ± 100th day. monitor wt. Home base mom¶s record. age of viability .20 ± 24 wks Term 37 ± 42 wks. age (high risk < 18 & >35 yrs old) record to determine high risk ± HBMR. 60 ± 70 day peak HCG.best to get urine exam. Health teaching: growth & development of fetus. culture & beliefs with respect. BP. non judgmental Occupation ± financial condition or occupational hazards. Obstetrical Data: nullipara ± no pregnancy a. 6 weeks after LMP. Third Trimester: . fantasy. Pre-Natal Visit: 1. Personal data ± name. (increase wt ± 1st sign preeclampsia) Weight Monitoring First Trimester: Normal Weight gain Second trimester: normal weight gain Third trimester: normal weight gain Minimum wt gain ± 20 ± 25 lbs Optimal wt gain ± 25 ± 35 lbs 1. HT: responsible parenthood µbaby¶s Layette´ ± best time to do shopping.# of viable pregnancy Viability ± the ability of the fetus to live outside the uterus at the earliest possible gestational age.) Elisa test ± test for preg detects beta subunit of HCG as early as 7 ± 10days 3.
3 months ± above sym pub 5 months ± level of umbilicus 9 months ± below zyphoid 10 months ± level of 8 months due to lightening 4. 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. Important Estimates: GP GTPAL 4 2 4 11 1 1 GP GTPAL 6 4 6 2 2 15 1. Begin TT3 TT1 ± any time during pregnancy TT2 ± 4 wks after TT1 ± 3 yrs protection . Bartholomew¶s Rule ± to determine age of gestation by proper location of fundus at abdominal cavity. 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 ± 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 . Haases rule ± to determine length of the fetus in cm. square @ month 2nd ½ of preg.1 add 1 month to month 11/31/04 EDD 2. Formula: 1st ½ of preg . 2nd ½ of preg tetanus immunizations ± prevents tetanus neonatum -mom with complete 3 doses DPT young age considered as TT1 & 2.
use palm! Warm palm. an estimate of the size. Examine teeth: sign of infection Danger signs of Pregnancy C .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 . abortion. incompetent cervix 3rd ± placental anomalies S ± sudden gush of fluid ± PROM (premature rupture of membrane) prone to inf. E ± edema to upper ext. universal precaution EXT OS of cervix ± site for getting specimen Site for cervical cancer Pap Smear ± cervical cancer . Leopold¶s Maneuver Purpose: is done to determine the attitude. Physical Examination: A. Procedure: Empty bladder Position of mom-supine with knee flex (dorsal recumbent ± to relax abdominal muscles) 6. presenting part.TT3 ± 6 months after TT2 ± 5 yrs protection TT4 ± 1 yr after TT3 ± 10 yrs protection TT5 ± yr after TT4 ± lifetime protection 5.normal Class IIA ± acytology but no evidence of malignancy B ± suggestive of infl.cancer extends to vagina 3 ± pelvis metastasis 4 ± affection to bladder & rectum 7. empty bladder 2. (preeclampsia) Pelvic Examination ± internal exam 1. position. 2.chills/ fever . fetal presentation lie. and number of fetuses. Prep mom: 1.composed of squamous columnar tissue Result: Class I . ectopic pre/2nd ± H mole. . 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 . degree of descent.
diabetes b. put towel under head and right hip. less vigorous Movement alarm signals . with both hands palpate upper abdomen and fundus. To determine degree of engagement. the head will be flexed and vertex presenting. Get V/S(before 2nd maneuver) PR to diff fundic soufflé (FHR) & uterine soufflé. often require further testing. shape. Examples: nonstress test (NST). To determine attitude ± relationship of fetus to 1 another.) more then 1 hour to reach 10 movements b. the head is extended.Assessment of Fetal Well-BeingA. With two hands.) less then 10 movements in 12 hours(non-reactive. grasp the symphis pubis part using thumb and fingers.1st maneuver: place patient in supine position with knees slightly flexed. Assess whether the presenting part is engaged in the pelvis )Alert : if the head is engaged it will not be movable).breakfast a.) maternal history of smoking. movement and firmness of the part to determine presentation 2nd Maneuver: with both hands moving down. Uterine soufflé ± maternal H rate 3rd Maneuver: using the right hand. Daily Fetal Movement Counting (DFMC) ±begin 27 weeks Mom.begin after meal . When the brow is on the same side as the back.< 3 FMs in 12 hours 4. Cardiff count to 10 method ± one method currently available (1) Begin at the same time each day (usually in the morning. 4th Maneuver: the Examiner changes the position by facing the patient¶s feet. Attitude ± relationship of fetus to a part ± or degree of flexion Full flexion ± when the chin touches the chest 8. 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. inadequate nutrition Procedure: .fetal distress) c. identify the back of the fetus ( to hear fetal heart sound) where the ball of the stethoscope is placed to determine FHT.) movement are becoming weaker. assess the descent of the presenting part by locating the cephalic prominence or brow. When the brow is on the same side as the small parts. biographical profile (BPP) B.) pregnancy induced hypertension (PIH). Nonstress test ± to determine the response of the fetal heart rate to activity Indication ± pregnancies at risk for placental insufficiency Postmaturity a.) longer time to reach 10 FMs than on previous days d.) warning signs noted during DFMC c.) warning signs should be reported to healthcare provider immediately. Assess size. after breakfast) and count each fetal movement.
complex carbohydrates .Foods of high nutrient value such Essential to supply energy for to maintain ideal body weight as protein. biophysical profile. Pregnant teenagers ± low compliance to heath regimen. DM 3. Baseline FHR between 120 and 160 beats per minute 2. noted as an uneven line on the rhythm strip. over wt ± candidate for HPN. 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 . At least two accelerations of the FHR of at least 15 beats per minute. result indicates a healthy fetus with an intact nervous system i.No more than 30% fat . Health teachings a. Could be indicative of a compromised fetus.Growth of fetus . Nonreactive result 1. fruits) .Begin increase in second sources for the nutrients requiring for trimester during pregnancy . ultrasound transducer over abdominal site where most distinct fetal heart sounds are detected 3. (BPP) or contraction stress test (CST) 9. Requires further evaluation with another NST. such as a CST Result: Noncreative Nonstress Not Good Reactive Responsive is Real Good Interpretation of results reactive result 1. ii. lasting at least 15 seconds in a 10 to 20 minute period as a result of FM 3. 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). Good variability ± normal irregularity of cardiac rhythm representing a balanced interaction between the parasympathetic (decreases FHR) and sympathetic (increase FHR) nervous system. 4.increased metabolic rate and meet energy requirement to (whole grains. Nutrition ± do nutritional assessment ± daily food intake High risk moms: 1.utilization of nutrients activity level .CHON x4. Extremes in wt ± underweight.Use weight ± gain pattern . (Decrease folic acid ± spina bifida/open neural tube defect) How many Kcal CHO x4. Low socio ± economic status 4.Development of structures . Stated criteria for a reactive result are not met 2.Variety of foods representing foods . mother activates the ³mark button´ on the electronic monitor when she feels fetal movement. Attach external noninvasive fetal monitors 1. vegetables. tocotransducer over fundus to detect uterine contractions and fetal movements (FMs) 2. external monitor is applied to document fetal activity.protein sparing so it can be used . Vegetarian mom ± decrease CHON ± needs Vit B12 ± cyanocobalamin ± formation of folic acid ± needed for cell DNA & RBC formation. 2.
margarine.Development of essential pregnancy structures . .Begin supplementation at 30. Protein Essential for: .Growth and development of fetal skeleton and tooth buds .Eggs. whole grain cereals and breads .iron from food sources is more readily absorbed when served with foods high in vit C . ice cream. nuts .enriched.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.Fetal tissue growth . red meat. tofu .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 .Current research is : Demonstrating an association between adequate calcium intake and the prevention of pregnancy induce hypertension Iron Essential for . .Dried beans. amniotic fluid. cheese.1600 mg/day is recommended for the adolescent. potatoes .Vitamin D sources: fortified milk. as an indication of adequacy of calorie intake. poultry.liver.required for pregnancy including placenta. liver.canned salmon & sardines w/ bones .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. egg yolk. dried fruits .inadequate iron intake results in maternal effects ± anemia depletion of iron Calcium increases should reflect: . seafood Iron increases should reflect .dairy products : milk. broccoli or cabbage. fish.1200 mg/day representing an increase of 50% above prepregnancy daily requirement.Maternal tissue growth including uterus and breasts . since diet alone is unable to meet pregnancy requirement .mg/day in second trimester.dark green leafy vegetables. and tissue growth. eggs .green leafy vegetables .Failure to meet caloric requirements can lead to ketosis as fat and protein are used for energy. egg yolk . 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 .Lean meat. poultry.Maintenance of mineralization of maternal bones and teeth . legumes .whole grains.nuts. fish . cheese. lentils.70 mg/day of vitamin C which enhances iron absorption .Expansion of blood volume and red blood cells formation .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 . milk . strawberries.Ca fortified foods such as orange juice .vitamin C sources: citrus fruits & juices. . cantaloupe. butter. ketosis has been associated with fetal damage.
Folate Essential for .) mom placed in comfy pos.) avoid blowing or air during cunnilingus f.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. 2. decreased energy and appetite.Zinc Essential for * the formation of enzymes * maybe important in the prevention of congenital malformation of the fetus. legumes. milk.dark green leafy vegetables.eggs.) should be done in private place c. veal .Magnesium . lean beef. Hard to excrete. Taking it not needed ± fat soluble vitamins.5 mg/day 1. incompetent cervix . broccoli. Vit stored in body. cheese .formation of red blood cells and prevention of anemia . abortion.Whole grains.Sexual Activity a. kidney. Zinc increases should reflect .iodine . 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.air embolism Changes in sexual desire: a.) should be done in moderation b. legumes.) 3rd trimester ± decreased desire Contraindication in sex: 1.Selenium Vitamins E Thiamine Riborlavin Pyridoxine ( B6) B12 Niacin stores. Folacin. cardiac stress especially labor and birth .) 2nd trimester ± increased desire due to increase estrogen that enhances lubrication c. peanuts 400 mcg/day representing an increase of more then 2 times the daily prepregnant requirement. meats .) avoided 6 weeks prior to EDD e. vaginal spotting 1st trimester ± threatened abortion 2nd trimester± placenta previa 2. Folic Acid. may play a role in the prevention of neutral tube defects (spina bifida). nuts Increases should reflect .liver.fetal effects decreased availability of oxygen thereby affecting fetal growth * iron deficiency anemia is the most common nutritional disorder of pregnancy.) changes in sexual desire of mom during preg.DNA synthesis and cell formation.shell fish .2 mg/day 2. sidelying or mom on top d.whole grains.6 mg/day 2.) 1st tri ± decrease desire ± due to bodily changes b. abruption placenta Additional Requirements Minerals . 15mcg/day representing an increase of 3 mg/day over prepreganant daily requirements. .liver.
) closed eye & appearance of sleep 2. Four extremities on floor Kegel Exercise ± strengthen pulococcygeal muscles . Different Methods of delivery: 1.) birthing chair ± bed convertible to chair ± semifowlers . exhale mouth 3. helping them achieved a satisfying and enjoying childbirth experience.) Must be individualized Walking ± best exercise 3. Effleurage ± gentle circular massage over abdominal to relieve pain 4. Psychoprophylaxis ± prevention of pain 1. Ferdinand Lamaze req.as if hold urine.) Done in moderation. Kitzinger method ± preg. 2. Grantly Dick Read Method ± fear leads to tension while tension leads to pain b. Lamaze: Dr.) quiet environment 3. preterm labor 4. Robert Bradley ± advocated active participation of husband at delivery process. Based on imitation of nature. Cleansing breathe ± inhale nose. labor & birth & care of newborn is an impt turning pt in woman¶s life cycle . premature rupture of membrane Exercise ± to strengthen muscles used during delivery process principles of exercise 1.exercise ± relieves low back pain & maintain good posture * arch back ± standing or kneeling. a. disciple. conditioning & concentration. Husband is coach Features: 1. Psychophysical 1. imaging ± sensate focus 5.) relaxation tech 4. Bradley Method ± Dr.strengthen chest muscles pelvic rocking/pelvic tilt.3. Squatting ± strengthen muscles of perineum. Increase circulation to perineum. Childbirth Preparation: Overall goal: to prepare parents physically and psychologically while promoting wellness behavior that can be used by parents and family thus.flow with contraction than struggle with contraction c. Psychosexual 1. Squat ± feet flat on floor Tailor Sitting ± 1 leg in front of other leg ( Indian seat) Raise buttocks 1st before head to prevent postural hypotension ± dizziness when changing position - shoulder circling exercise. release 10x or muscle contraction Abdominal Exercise ± strengthens muscles of abdominal ± done as if blowing candle 4. Conscious relaxation 2.) darkened rm 2. Features: 1.
) 4. Admitting the laboring Mother: Personal Data: name. age.) theory of aging placenta ± life span of placenta 42 wks. Intrapartal Notes ± inside ER A.biparietal ± largest transverse . b. 1 x 1 cm. soft music.) Posterior fontanel or lambda ± triangular shape.) Anterior fontanel ± bregma.( > 5 cm ± hydrocephalus). decrease progesterone will stimulate contractions & labor 5.bitemporal 8 cm 2. complete flexion. bimastoid 7cm smallest transverse Sutures ± intermembranous spaces that allow molding. baby gets warm bath.) coronal suture ± connect parietal & frontal bone (crown) 3. Fetal head ± is the largest presenting part ± common presenting part ± ¼ of its length. diamond shape. dark.2.close 2. 1 Theories of the Onset of Labor 1. transverse diameter ± 9. 12 ± 18 months after birth. comfy room.Pelvic Exams B. 1.25cm .) Anteroposterior diameter suboccipitobregmatic 9. 3 x 4 cm. will always contract & expel its content) ± contraction action 2.) progesterone theory ± before labor. 4. b. After delivery.5 cm hyper extension submentobragmatic-face presentation 2. Closes ± 2 ± 3 months. Passenger a.) sagittal suture ± connects 2 parietal bones ( sagitna) 2. Hypothalamus produces oxytocin 3. smallest AP occipitofrontal 12cm partial flexion occipitomental ± 13.) Underwent pelvic dislocation .) uterine stretch theory ( any hallow organ stretched.2.viable preg. address. The 4 P¶s of labor 1. etc Baseline Data: v/s esppecially BP. quiet. Birth under H20 ± bathtub ± labor & delivery ± warm water.) oxytocin theory ± post pit gland releases oxytocin. At 36 wks degenerates (leading to contraction ± onset labor).) birthing bed ± dorsal recumbent pos squatting ± relives low back pain during labor pain leboyers ± warm. Basic knowledge in Intrapartum.sinciput E ± ethmoid O ± occuputal .) < 4¶9´ tall 2.) 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.occiput T ± temporal P ± parietal 2 x Measurement fetal head: 1.5 cm. Bones ± 6 bones S ± sphenoid F ± frontal . IX.) 5. para. Passageway Mom 1.) < 18 years old 3. ± 22 ± 24 wks Physical Exams.contraction 4.) 3.) prostaglandin theory ± stimulation of arachidonic acid ± prostaglandin. weight Obstetrical Data: gravida # preg.
Increase Activity of the Mother. (DC ± 11. Pelvis 2 hip bones ± 2 innominate bones 3 Parts of 2 Innominate Bones Ileum ± lateral side of hips . ape like pelvis. intensity 4. Support System Pre-eminent Signs of Labor S&Sx: . wide. posterior part shallow 3. Braxton Hicks Contractions ± painless irregular contractions 3. Characteristics: wave like d. Measurement: 11. Psyche/Person ± psychological stress when the mother is fighting the labor experience a. Ripening of the Cervix ± butter soft 5.anterior part pointed.2 weeks prior to EDD * Engagement. will be used for delivery.0 cm 3.nesting instinct. Power ± the force acting to expel the fetus and placenta ± myometrium ± powers of labor a.urinary freq.5 ± 3 lbs 6. True conjugate/conjugate vera ± measure between the anterior surface of the sacral promontory and superior margin of the symphysis pubis. Anthropoid ± oval. Bloody Show ± pinkish vaginal discharge ± blood & leukorrhea 7. Check FHT .iliac crest ± flaring superior border forming prominence of hips Ischium ± inferior portion . Platypelloid ± flat AP diameter ± narrow. 1.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. Tuberoischi Diameter ± transverse diameter of the pelvic outlet. Involuntary Contractions b. Rupture of Membranes ± rupture of water.12. 3. deeper most suitable (normal female pelvis) for pregnancy 2.5 cm basis in getting true conjugate. Cultural Interpretation b. Ischial tuberosity ± approximated with use of fist ± 8 cm & above. Preparation c. Lightening ± setting of presenting part into pelvic brim . Past Experience d.5 cm .Pelvis 4 main pelvic types 1. Obstetrical conjugate ± smallest AP diameter.5 cm=true conjugate) 2. Diagonal Conjugate ± measure between sacral promontory and inferior margin of the symphysis pubis. Save energy.shooting pain radiating to the legs . Gynecoid ± round. Pelvis at 10 cm or more. duration. oval shape. Increase epinephrine 4. decreased body wt ± 1. AP diameter wider transverse narrow 4. Measurement: 11.setting of presenting part into pelvic inlet 2. Timing: frequency. Voluntary bearing down efforts c. transverse ± wider b. Android ± heart shape ³male pelvis´.
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. upper uterine . Cover cord with sterile gauze with saline to prevent drying of cord so cord will remain slippery & prevent cord compression causing cerebral palsy. 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. Unit used is cm.fundus 2. Slip cord away from presenting part 3. Use % in unit of measurement Dilation ± widening of cervix. especially if fetal distress is noted Cord Prolapse ± a complication when the umbilical cord falls or is washed through the cervix into the vagina. Danger signs: PROM Presenting part has not yet engaged Fetal distress Protruding cord form vagina Nursing care: 1. Count pulsation of cord for FHT 4. Nursing Interventions in Each Stage of Labor 2 segments of the uterus 1. lower uterine ± isthmus . 2.Premature Rupture of Membrane ( PROM) . Duration of Labor Primipara ± 14 hrs & not more than 20 hrs Multipara ± 8 hrs & not > 14 hrs Effacement ± softening & thinning of cervix. 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.
Encourage to void q 2 ± 3 hrs ± full bladder inhibit contractions 3. Encourage walking . 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. cervical dilation and effacement. 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. Breathing ± chest breathing Active Phase: Assessment: Dilations 4 -8 cm Intensity: moderate Mom.shorten 1st stage of labor 2.1 station = presenting part 1cm above ischial spine if (-) floating . apprehensive. can communicate Frequency: every 5 ± 10 min Intensity mild Nursing Care: 1.2 station = presenting part 2 cm above ischial spine if (-) floating 0 station = level at ischial spine ± engagement + 1 station = below 1 cm ischial spine +3 to +5 = crowning ± occurs at 2nd stage of labor b. fetal monitor. Latent Phase: Assessment: Dilations: 0 ± 3 cm mom ± excited. First Stage: onset of true contractions to full dilation and effacement of cervix. Station ± landmark used: ischial spine . 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.1.1.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. etc.
if same BP. 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.)To cleanse bowel b.)Enema administer during labor a. RST. double Kneeling b. notify MD -preeclampsia Health teachings 1. LSP. RMT. LMT.)Prevent infection c.will cause aspiration 3. most painful ROP ± squatting pos on mom ROT ROA Breech. RSA.use sacrum . If BP increase . RSP Chin / Mento LMA. RMP. let mom rest.) Ok to shower 2.)Sims position/side lying 12 ± 18 inch ± ht enema tubing . 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 . RADA LSA ± left sacro anterior LST. LMP. breast lie on thigh Incomplete Breech ± thigh rest on abdominal Frank ± legs extend to head Footling ± single.)NPO ± GIT stops function during labor if with food.put stet above umbilicus Shoulder/acromniodorso LADA.strength of contraction Contraction ± vasoconstriction Increase BP. c. Shoulder presentation. Transverse Lie (Perpendicular) or Perpendicular lie. LADT. Position ± relationship of the fatal presenting part to specific quadrant of the mother¶s pelvis. 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.Breech - Complete Breech ± thigh breast on abdomen.2. LADP.
placenta has 15 ± 28 cotyledons . shorten 2nd stage of labor. Nursing Care: To prevent puerperal sepsis . (Support head & remove secretion. Descent 3.)To prevent laceration 2.Check FHT after adm enema Normal FHT= 120-160 Signs of fetal distress1.) fetal thrushing ± hyperactive fetus due to lack O2 2. Cavity Two Major Divisions of Pelvis 1. hard to repair. complete dilation and effacement to birth. Lengthening of the cord 3. widen vaginal canal. less pain easy to repair. False pelvis ± above the pelvic inlet. Pull shoulder down & up. supports uterus during pregnancy Linea Terminales diagonal imaginary line from the sacrum to the symphysis pubis that divides the false and true pelvis. 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.) mecomium stain amnion fluid 3. Flexion 4. slow to heal -use local or pudendal anesthesia.to prevent laceration. identification of baby. Third Stage: birth to expulsion of Placenta -placental stage Placenta delivered from 3-10 minutes Signs of placental separation 1. Expulsion Three parts of Pelvis ± 1. Extension 6. Episiotomy ± median ± less bleeding. Ironing the perineum ± to prevent laceration Modified Ritgens maneuver ± place towel at perineum 1. check cord if coiled.) Will facilitate complete flexion & extension. True pelvis ± below the pelvic inlet 2. External rotation 7. Internal Rotation 5. Second Stage: fetal stage.) <120 & >160 2. fast to heal. Mechanisms of labor 1. transverse diameter wider 2.< 48 hours only ± vaginal pack Bolus of Ptocin can lead to hypotension. Inlet ± AP diameter narrow. Engagement 2. possible to reach rectum ( urethroanal fistula) Mediolateral ± more bleeding & pain. Check time. Fundus rises ± becomes firm & globular ³ Calkins sign´ 2.
Blanket./diazepam ± muscle relaxant 2.intense excessive contractions resulting to ineffective pushing . massage uterus) 6.) Straight rooming in baby: 24hrs with mom.edness E. Count pad & saturation 4. give clear liquid-tea. Fully soaked pad : 30 ± 40 cc weigh pad. Fourth Stage: the first 1-2 hours after delivery of placenta ± recovery stage. Check perineum for lacerations 10. Assist MD for episiorapy 11. clear gelatin.) hypotonic ± secondary uterine inertia. at night nursery Complications of Labor Dystocia ± difficult labor related to: Mechanical factor ± due to uterine inertia ± sluggishness of contraction 1. Nsg care for placenta: 4. deviation of fundus 1.) Partial rooming in: baby in morning . Flat on bed 12.3. Monitor v/s q 15 for 1 hr. Check bp 7. Bonding ± interaction between mother and newborn ± rooming in types 1. 2. 5. Check fundus (if relaxed. Monitor hpn (or give oxytocin IV) 9. If fundus above umbilicus.) Empty bladder to prevent uterine atony 2. Check placement of fundus at level of umbilicus. 1 gram=1cc e. Chills-due dehydration. . ginger ale.dema E . Maternal Observations ± body system stabilizes b.cchemosis D ± ischarges A ± approximation of blood loss. 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.) Check lochia a. Let mom sleep to regain energy. Check completeness of placenta.slow irregular contraction resulting to ineffective pushing.MD administer sedative valium. Perineum ± R . 2nd hr q 30 minutes. Administer methergine IM (Methylergonovine Maleate) ³Ergotrate derivatives 8. Placement of the Fundus c.) hypertonic or primary uterine inertia . Lochia d. Give oxytocin.
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.maternal effect ± exhaustion. Fetal effect ± fetal distress.) short cord 2. Mom given 6 hrs of labor Multi: 8 ± 14. etc. caput succedaneum or cephal hematoma .) hypovolemic shock d.bleeding to all portions of the body ± eyes.nsg care: monitor contractions and FHR Precipitate Labor .) ineffective fundal pressure Uterine Rupture Causes: 1.) hurrying of placental delivery 3.) profuse bleeding c.) sudden pain b. extensive lacerations.)Large baby 3. chest pain & frothy sputum prepare: suctioning end stage: DIC disseminated intravascular coagopathy.) 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. 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 .Boundary bet upper/lower uterine segment BANDL¶S pathologic ring ± suprapubic depression a.)Previous classical CS 2. Factors leading to inversion of uterus 1. primi 14 ± 20 Preterm Labor ± labor after 20 ± 37 weeks) ( abortion <20 weeks) Sx: 1.labor of < 3 hrs. MD will push uterus back inside or not hysterectomy. hypovolemic shock if with bleeding. premature contractions q 10 min .) 1.) TAHBSO Physiologic retraction ring . Trial Labor ± measurement of head & pelvis falls on borderline.) Improper use of oxytocin (IV drip) Sx: a. nose.
Postpartal Period 5th stage of labor after 24hrs :Normal increase WBC up to 30.000 cumm Puerperium ± covers 1st 6 wks post partum Involution ± return of repro organ to its non pregnant state. consult MD if symptoms persist Hosp: 1.prone to thrombus formation .(puerperal sepsis). effacement of 60 ± 80% 3. Vaginal and Pelvic Floor c.D&C after. 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.a medium for bacterial growth. Hyperfibrinogenia . empty bladder 4. X. Genital tract a. Physiologic Changes a.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. Uterus ± return to normal 6 ± 8 wks.halts preterm contractions. complete bed rest 2. Systemic Changes 1. Monitor: FHT > 180 bpm Maternal BP . birth pain: 1. Cervix ± cervical opening b. This is critical especially to gravidocardiac mothers. dilation saved by administer Tocolytic agents. avoid sex 3.early ambulation Principles underlying puerperium 1. If cervix is closed 2 ± 3 cm. To return to Normal and Facilitate healing A.1.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.Yutopar Hcl) 150mg incorporated 500cc Dextrose piggyback.<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. position prone . Cardiovascular System . dilation 2-3 cm Home Mgt: 1. drink 3 -4 glasses of water ± full bladder inhibits contractions 5.
Mgt: 1.urinary retention with overflow 4. not compress sex. Taking in phase ± dependent phase (1st three days) mom ± passive. can make decisions HT: 1. 1. microorganism. Perineal area ± painful ± episiotomy site ± sims pos. ± let mom cry ± therapeutic. Urinary tract: Bladder ± freq in urination after delivery. Baggy or relaxed uterus & profuse bleeding ± uterine atony.) Care of newborn 2. Colon: Constipation ± due NPO.inability to sleep & lack of appetite.) 1st degree laceration ± affects vaginal skin & mucus membrane. 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. deciduas. Nsd & Cs with lochia. Ruba ± red 1st 3 days present.stimulate bladder 3. wbc. activity is to tell child birth experiences. Lochia-bld. Serosa ± pink to brown 4 ± 9th day.alternate warm & cold compress .) Insert family planting method common post partum blues/ baby blues present 4 ± 5 days 50-80% moms ± overwhelming feeling of depression characterized by crying. musty/mousy. Alba ± créme white 10 ± 21 days very decreased amt dysuria . Hemorrhage ± bleeding of > 500cc CS ± 600 ± 800 cc normal NSD 500 cc Early postpartum hemorrhage± bleeding within 1st 24 hrs. massage uterus until contracted cold compress modified trendelenberg IV fast drip/ oxytocin IV drip I. Letting go ± interdependent phase ± 7 days & above. III. cold compress for immediate pain after 24 hrs. mefenamic acid d.2. Complications: hypovolemic shock. Taking hold phase ± dependent to independent phase (4 to 7 days). c. moderate amt 2. cant make decisions.) 4. cold compress ± to prevent bleeding 3. hot sitz bath.urine collection . fear of bearing down 5.when perineum has healed II. Mom is active.proper hygiene b. despondence.redefines new roles may extend until child grows. Prevent complications 1. Nursing Care: . . Mom .) 3.) 2. Provide Emotional Support ± Reva Rubia Psychological Responses: a. limited amt 3.
bleeding to any part of body . Motivate the use of Family Planning 1.) incision on site. Natural Method ± the only method accepted by the Catholic Church .) anaerobic streptococci ± most common .cryoprecipitate or fresh frozen plasma II. paracetamol.sources of infection 1. D&C except placenta increta. TSB.) supportive care ± CBR. Late Postpartum hemorrhage ± bleeding after 24 hrs ± retained placental fragments Mgt: D&C or manual extraction of fragments & massaging of uterus.failure to coagulate. Hypofibrinogen. . dolor (pain) tumor(swelling) 2. percreta.Well contracted uterus + bleeding = laceration . VITC. . saline. scraping & suturing Infection.) unhealthy sexual practices General signs of inflammation: 1. cold compress. purulent discharges 3.too much manipulation . rubor (red). 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.) method of choice is an individuals choice. Fowlers ± to facilitate drainage & localize infection oxytocin & antibiotic IV. Endometriosis ± inflammation of endometrial lining Sx: Abdominal tenderness.) determine one¶s own beliefs 1st 2.) exogenous ± from outside 1. pos.large baby . between & resulting. 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.)endogenous ± from within body 2. Inflammation ± calor (heat).) shave 3.pudendal anesthesia Mgt: 1. fever Gen mgt: 1.degree of laceration .) never advice a permanent method of planning 3. hydration.assess perineum for laceration .) cold compress every 30 minutes with rest period of 30 minutes for 24 hrs 2.from members health team 2. Acreta ± attached placenta to myometrium.hysterectomy if with abruption placenta mgt: BT.mgt episiorapy DIC ± Disseminated Intravascular Coagulopathy.
coitus reservatus ± sex without ejaculation ± 3. elastic ± long spinnbarkeit Basal Body Temperature 13th day temp goes down before ovulation ± no sex .9% effective. 99.) coitus interuptus/ withdrawal . Consult OB-6mos.18 8 Dec 33 -11 22 unsafe days 21 day pill.get before arising in bed LAM ± lactation amenorrheal method ± hormone that inhibits ovulation is prolactin.-get short test & longest cycle from Jan ± Dec .Billings / Cervical mucus± test spinnbarkeit & ferning (estrogen) .start 5th day of mens 28day pill.least effective method 2.clear.headache E ± eye problems S ± severe leg cramps .3 months.shortest ± 18 . Alerts on Oral Contraceptive: -in case a mother who is taking an oral contraceptive for almost long time plans to have a baby. calendar method OVULATION ±count minus 14 days before next mens (14 days before next mens) Origoknause formula ± .longest ± 11 June 26 . Signs of hypertension Immediate Discontinuation A ± abdominal pain C ± chest pain H . coitus interfemora ± ³ipit´ 4. watery. . . 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.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. Best method Social Method ± 1. stretchable. 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.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.monitor cycle for 1 year .menstruation will come out 4 ± 6 months bottle fed 2 ± 3 months disadvantage of lam ± might get pregnant Symptothermal ± combination of BBT & cervical.
) Thrombophlebitis or problems in clotting factors if forgotten for one day.as soon as removed ± can become pregnant Mechanism and Chemical Barriers Intrauterine Device (IUD) Action: prevents implantation ± affects motility of sperm & ovum . it will shorten duration Norplant ± has 6 match sticks ± like capsules implanted subdermally containing progesterone. .) Monthly checkup 3.5 yrs ± disadvantage if keloid skin .it gives higher protection in the prevention of STDs Diaphragm ± rubberized dome shaped material inserted to cervix preventing sperm to get to the uterus. . REVERSABLE .parity or # of children. fever.) HPN 4. immediately take the forgotten tablet plus the tablet scheduled that day. chills S trings lost.) Regular pap smear Alerts.most common complications: excessive menstrual flow and expulsion of the device (common problem) . uterine perforation. If forgotten for two consecutive days. ectopic pregnancy Condom ± latex inserted to erected penis or lubricated vagina Adv.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.) Check for string daily 2.If mom HPN ± stop pills STAT! Adverse effect: breakthrough bleeding Contraindicated: 1. or more days.) DM 5.) chain smoker 2. use another method for the rest of the cycle and the start again.right time to insert is after delivery or during menstruation primary indication for use of IUD .never massage injected site. DMPA ± depoproveda ± has progesterone inhibits LH ± inhibits ovulation Depomedroxy progesterone acetate ± IM q 3 months .prevents implantation . gives highest protection against STD ± female condom Alerts: Disadvantage: .it lessen sexual satisfaction .) extreme obesity 3. if 1 kid only don¶t use IUD HT: 1. shorter or longer Uterine inflammation.
) plasma germ defect Classifications: a. scanty dark brown bleeding .) 3.) Incomplete ± Placental and membranes retained. circlage is removed. safe XI.) 5. product of conception remain in uterus 4 weeks or longer.) CBR 2.) blighted ovum 3.) Avoid sex 3. Hemorrhagic Disorders General Management 1. jellies. HT: avoid lifting heavy objects Vasectomy ± cut vas deferense. Barrier ex.) chromosomal alterations 2. Missed ± fetus dies. Threatened ± pregnancy is jeopardized by bleeding and cramping but the cervix is closed Inevitable ± moderate bleeding.) 2. cramping.) Complete ± all products of conception are expelled. NSD Sheridan ± permanent surgery cervix. No mgt just emotional support! 2. signs of pregnancy cease. Present 2nd trimester d. 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. HT: >30 ejaculations before safe sex O ± zero sperm count. Abortions ± termination of pregnancy before age of viability (before 20 weeks) Spontaneous Abortion. CS c.) Assess for bleeding (per pad 30 ± 40cc) (wt ± 1gm =1cc) 4.) Signs of Hypovolemic shock 6.miscarriage Cause: 1. Jellies. High Risk Pregnancy 1. Habitual ± 3 or more consecutive pregnancies result in abortion usually related to incompetent cervix. During delivery. (-) preg test. b.) Ultrasound to determine integrity of sac 5.) 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. Foam (most effective). tissue protrudes form the cervix (Cervical dilation) Types: 1. infection. Mgt: D&C Incompetent cervix ± abortion McDonalds procedure ± temporary circlage on cervix S/E.) Save discharges ± for histopathology ± to determine if product of conception has been expelled or not First Trimester Bleeding ± abortion or eptopic A.) 4. Bilateral Tubal Ligation ± can be reversed 20% chance.Ht: 1. Creams Surgical Method ± BTL .
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. producing a diploid number 46 XX. Recurs. Avoid pregnancy for at least one year Third Trimester Bleeding ³Placenta Anomalies´ D.sudden . C. 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. .interstitial Unruptured Tubal rupture .scant.Mgt: induced labor with oxytocin or vacuum extraction 5.gestational anomaly of the placenta consisting of a bunch of clear vesicles. it grows & enlarges the uterus vary rapidly. dark brown.) Induced Abortion ± therapeutic abortion to save life of mom.candidate for CS Sx: frank . Placenta Previa ± it occurs when the placenta is improperly implanted in the lower uterine segment.abdominal pain within 3 -5 weeks of missed radiating to shoulder. common site: tubal or ampular Dangerous site . ± with fertilization. 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. sharp. Ectopic Pregnancy ± occurs when gestation is located outside the uterine cavity. sometimes covering the cervical os.missed period . period (maybe generalized or one sided) shoulder pain (indicative of intraperitoneal bleeding . Double effect choose between lesser evil. . Hydatidiform Mole ³bunch or grapes´ or gestational trophoblastic disease. This neoplasm is formed form the selling of the chronic villi and lost nucleus of the fertilized egg. Unilateral . The nucleus of the sperm duplicates. severe pain. Progressive degeneration of chorionic villi.
cord divides into small vessels before it enters the placenta Vasa Previa ± velamentous insertion of cord has implanted in cervical OS - F. Hypertensive Disorders I.HPN after 24 wks of pregnancy. 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. Pregnancy Induced Hypertension (PIH).Bright red Painless bleeding Dx: Ultrasound Avoid: sex. K. board like or rigid uterus. prepare to administer blood Type and crossmatch Monitor FHR Insert Foley Measure blood loss. H. . painful bleeding. Assessment: Concealed bleeding (retroplacental) Couvelaire uterus (caused by bleeding into the myometrium)-inability of uterus to contract due to hemorrhage. 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. I. G. Abruptio Placenta ± it is the premature separation of the placenta form the implantation site. 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. It usually occurs after the twentieth week of pregnancy. L. 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. 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. solved 6 weeks post partum. 2. J.
hyperglycemia 3 degrees GTT of > 130 mg/dL . sodium excretion. Provide safety.) minimal handling ± planning procedure 3.) Eclampsia ± with seizure! Increase BUN ± glomerular damage. BP decrease 2. antidote ± Ca gluconate 3. water immersion will cause to urinate.Diabetes Mellitus . P. E ± ensure high protein intake ( 1g/kg/day) . Transissional Hypertension ± HPN between 20 ± 24 weeks III. quiet calm environment 2.) increase wt due to edema b.) common in multiple pre (twins) increase exposure to chorionic villi 3.) HELLP syndrome ± hemolysis with elevated liver enzymes & low platelet count II. epigastric pain due to liver edema and oliguria usually indicates an impending convulsion. Patella reflex absent ± 1st sigh Mg SO4 toxicity. facilitate. Cause of preeclampsia 1.tongue depressor .) BP 140/90 c.) Mild preeclampsia ± earliest sign of preeclampsia a.) avoid jarring bed P.) Gestational hypertension .) dimly lit room . protenuria +3 .) common to mom with low socioeconomic status due to decrease intake of CHON Nursing care: P ± romote bed rest to decrease O2 demand.1.Na ± in moderation A ± anti-hypertensive drug Hydralazine ( Apresoline) C ± convulsion. BP 160/110 .turning to side done AFTER seizure! Observe only! for safely.prepare the following at bedside .) protenuria +1 . prevent ± Mg So4 ± CNS depressant E ± valuate physical parameters for Magnesium sulfate Magnesium SO4 Toxicity: 1. Resp < 12 4.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 . Chronic or pre-existing Hypertension ±HPN before 20 weeks not solved 6 weeks post partum.) idiopathic or unknown common in primi due to 1st exposure to chorionic villi 2.+2 2.prevent convulsions by nursing measures or seizure precaution 1. Three types of pre-eclampsia 1.) Pre-eclampsia ± HPN with edema & protenuria or albuminuria HE P/A 3.+4 3.HPN without edema & protenuria H without EP 2.) Severe preeclampsia Signs present: cerebral and visual disturbances. Urine output decrease 3.
Fetal effect 1. 5.moderate limitation of physical activity.) anticoagulant ± heparin doesn¶t cross placenta Class I & II.) hyperinsulinism 2. No valsalva maneuver Regional anesthesia! Low forcep delivery due to inability to push. 2nd ± 3rd trim ± hyperglycemic 2.< 7mg% Sx: Calcemia tetany Trousseau sign Give calcium gluconate if decrease calcium Recommendation Therapeutic abortion If push through with pregnancy 1.) 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. Heart disease Moms with RHD at childhood Class I ± no limit to physical activity Class II ± slight limitation of activity. administer dextrose 3.) hyper & hypoglycemia 2.) sleep 10 hrs a day 2.) Dystocia-difficult birth due to abnormalities in fetus or mom.) early hospitalization by 7 months Class IV. Post partum decrease 25% due placenta out.) Polyhydramnios 4.) macrosomia ± large gestational age ± baby delivered > 400g or 4kg 3.moniliasis 3.) rest 30 minutes & after meal Class III .maternal effect DM 1.) Frequent infection. marked limitation of physical activity. decrease in insulin by 33% in 1st tri.) hypocalcemia . 50% increase insulin at 2nd ± 3rd trimester.) antibiotic therapy.) Insulin requirement. for vaginal delivery. Ordinary activity causes fatigue & discomfort. not CS! NOT lithotomy! High semi-fowlers during delivery.good progress for vaginal delivery Class III & IV. Recommendation: Therapeutic abortion .to prevent sub acute bacterial endocarditis 2. Ordinary activity causes discomfort Recommendation: 1. It will shorten 2nd stage of labor. Even at rest there is fatigue & discomfort. Recommendation of class I & II 1.) Hypo or hyperglycemia ± 1st trimester hypo.) preterm birth to prevent stillbirth Newborn Effect : DM 1.poor prognosis.
) chain smoker administer: clomid ( chomephine citrate) to induce spermatogenesis Mgt: GIFT= Gamete Intra Fallopian Transfer for low sperm count Implant sperm in ampula 1.) Secondary ± 1st pregnancy.) . If >15 ± low sperm count Best criteria.truck driver 2. Abruptio placenta g.) fundal pressure . Due to increase prolactin ± hyperprolactinemia Administer.XII.Manageable STERILITY . Active herpes II d. Low segment ± bikini line type ± aesthetic use VBAC ± vaginal birth after CS INFERTILITY .) Tubal Occlusion ± tubal blockage ± Hx of PID that has scarred tubes . Multiple gestation b. Prolapse of the cord h. Diabetes c. Intrapartal complications 1. Within a year of attempting it .need: sperm only .use of IUD . classical ± vertical insertion. Cesarean Delivery Indications: a.) primary ± no pregnancy at all 2.irreversible Impotency ± inability to have an erection 2 types of infertility 1. CPD primary indication i.more practical & less complicated .) Mom: anovulation ± no ovulation.sperm motility for impotency Factors: low sperm count 1. Transverse lie Procedure: a. Once classical always classical b.inability to achieve pregnancy. Placenta previa f. parlodel ( Bromocryptice Mesylate) Action. Breech presentation j. 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.Sims Huhner test ± or post coital test. no more next preg test male 1st .sterile bottle container ( not plastic has chem. 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. antihyper prolactineuria Give mom clomid: action: to induce oogenesis or ovulation S/E: multiple pregnancy 2.) occupation.
) episiotomy 3.2.) forcep delivery .
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