MATERNAL AND CHILD NURSING – Broad and Round

Human Sexuality Ligaments – provide upper support for the

● Human Sexuality-behavior of being a boy or a girl, female/male uterus.
● An entity subject to a lifelong dynamic change – Cardinal, Pubocervical,
● Developed at the time of birth and Uterosacral Ligaments – suspensory
● Involves emotions, attitudes, sexual self eroticism and provide middle support.
Related concepts: – Pelvic Muscular Floor
● Sex- biologic male or female Ligaments – provide lower support.
● Gender identity-sense of femininity or ● FALLOPIAN TUBES – extend
musculinity from the upper outer angles of the uterus and
● Developed between 2-4 years of age end near the ovary. Passageway for the ovum
● Role identity- attitudes, behavior and attributes that differentiate role to travel to the uterus.
EXTERNAL ORGANS ● OVARIES – female sex glands
● MONS PUBIS – mound of fatty tissue over the symphysis pubis that cushion and located on each side of the uterus.
protects the bone. Stage 3: 12-13 y/o
● LABIA MAJORA – longitudinal folds of pigmental skin extending from the mons ● hair becomes
pubis to the perineum. darker that develop along the pubic
● LABIA MINORA – soft longitudinal skin folds between the labia majora. symphysis
● CLITORIS – erectile tissue located at the upper end of the labia minora. Stage 4: 13-14 y/o
● URETHRAL MEATUS – small opening of the urethra. Located between the clitoris ● hair assumes
and the vaginal orifice. the normal appearance of an adult
● SKENE OR PARAURETHRAL GLANDS – small mucus-secreting glands that but not so thicked
lubricate the vagina ● doesn’t appear in the inner aspect of the upper
● VESTIBULE – almond-shaped area between the labia minora containing the vaginal thigh
introitus, hymen, and Bartholin glands. Stage 5: Sexual maturity, hair assumes the normal
● VAGINAL INTROITUS – external opening of the vagina. appearance of an adult
● HYMEN – membranous tissue ringing the vaginal introitus. ● appears on the inner aspect of the upper thigh
● BARTHOLIN OR VULVOVAGINAL GLANDS – mucus-secreting glands located PELVIS AND BREASTS
on either side of the vaginal orifice. ● TYPES OF PELVES:
● PERINEUM – area of tissue between the anus and vagina. – GYNECOID – typical female pelvis with a ROUNDED INLET.
– ANDROID – normal male pelvis with a HEART-SHAPED INLET.
– ANTHROPOID – an “APELIKE” pelvis with an OVAL INLET.
Pubic hair development: Tanner’s stages – PLATYPELLOID – is a flat, female-type pelvis with a TRANSVERSE
Stage 1: Pre adolescent OVAL INLET.
● No pubic hair except for fine body hair
● BREASTS:
Stage 2: – Are specialized sebaceous glands that produce milk after childbirth.
11-12 y/o – Internal breast structures include glandular tissue, lactiferous ducts or
sparse, long slightly pigmented and sinuses, Cooper ligaments and adipose and fibrous tissues.
curly hair that develop along the labia – External structures include the nipple, areola and Montgomery tubercles.
INTERNAL ORGANS
● VAGINA – female organ of MENSTRUAL CYCLE AND HORMONES
copulation and also serves as the birth canal. ● MENARCHE – (onset of menstruation) typically occurs between 10 and 13 years old.
Lies between the rectum and the urethra and ● MENSTRUAL CYCLE – is a monthly pattern of ovulation and menstruation.
bladder. – OVULATION – is the discharge of a mature ovum from the ovary.
● UTERUS – hollow, muscular organ – MENSTRUATION – is the periodic shedding of blood, mucous, and
with three muscle layers (perimetrium, epithelial cells form the uterus (average blood loss is 50 ml)
myometrium and endometrium). Located ● HORMONES
between the bladder and rectum. Consists of – ESTROGEN – contributes to the characteristics of femaleness
the fundus, body(corpus) and cervix. – PROGESTERONE – (hormone of pregnancy) quiets or decreases the
● UTERINE LIGAMENTS contractility of the uterus.
 – PROSTAGLANDINS – regulate the reproductive process by stimulating the – Bp suddenly returns to normal
contractility of uterine and other smooth muscles. ● 5. Refractory phase- period where men cannot
● LEVELS OF THE MENSTRUAL CYCLE be re stimulated within 10-15 minutes
– CNS RESPONSE – Follicle Stimulating Hormone (FSH) and Luteinizing Ejaculation sperm deposited in the fornix of vagina travel thru the uterus FT
Hormone (LH) Ampulla Fertilization of egg
– OVARIAN RESPONSE – Follicular phase (days 1 – 14) due to FSH; Luteal
phase (days 15 – 22) corpus luteum develops FETAL STAGES OF DEVELOPMENT
– ENDOMETRIAL RESPONSE ● ZYGOTE = union of ovum and sperm
● Menstrual phase (days 1 – 5) estrogen level is low ● MORULA = 16 – 50 cells; 3 – 4 days after fertilization
● Proliferative phase (days 1 -14) estrogen level is high – ovulation ● BLASTOCYST = enlarged cell w/ fluid filled structure; trophoblast ( becomes
occurs on day 14 of a 28-day cycle placenta and membrane )
● Secretory phase (days 14 – 26) progesterone is high ● EMBRYO = 3 – 8 weeks; embryonic structures
● Ischemic phase (days 27 – 28) estrogen and progesterone levels ● FETUS = 2 months – birth
recede – menstruation begins PRENATAL PERIOD
– CERVIX AND CERVICAL MUCOUS RESPONSE FIRST, SECOND AND THIRD TRIMESTERS OF PREGNANCY
● Before ovulation – estrogen levels rise, high spinnbarkeit, excellent FIRST TRIMESTER OF PREGNANCY
sperm penetration ● The first trimester (from 0-12 Weeks) allows the pregnant woman’s body to undergo
● After ovulation – progesterone levels rise, low spinnbarkeit, poor many changes as it adjusts to the growing baby.
sperm penetration ● It is important to understand that these are all normal events and that most of these
● During pregnancy – cervical circulation increases and a protective discomforts will go way as the pregnancy progresses.
mucus plug forms. ● So included here are some of the symptoms experienced during pregnancy and how
● CLIMACTERIC PERIOD AND MENOPAUSE best to deal with them:
– Climacteric Period – is a transitional period during which ovarian function – Breast changes
and hormonal production decline. – Tiredness
– Menopause – refers to a woman’s last menstrual period. – Mood Changes
Menstrual problems – Nausea and Vomiting
● Dysmenorrhea- painful menstruation due to increase – Frequency of Urination
prostaglandin – Gastrointestinal Symptoms
● Amenorrhea- absence of menstruation – Dizziness
● Metrorrhagia- bleeding in between menstruation – Varicose Veins and Hemorrhoids
● Menorrhagia- excessive bleeding during – Leg Cramps
menstruation – Increased heart rate
● Menopause- cessation of menstruation SECOND TRIMESTER OF PREGNANCY
- 47 y/o average menopausal age ● The second trimester (13-28 Weeks) is the most physically enjoyable for most women.
- decrease estrogen osteoporosis ● While some symptoms such as a morning sickness and nausea can abate, new ones can
2. Plateau phase- increased congestion to sustained tension nearing orgasm begin.
- Vs are high ● What follows is a list of changes that could be seen in a pregnant woman’s body during
- lasting 30 seconds to 3 minutes this trimester.
3. Orgasmic phase- diminished sensory awareness – Appetite Increase
- involuntary release of sexual tension accompanied by physiologic & psychologic – Increase belly size, stretch marks and skin changes
release known as the peak of sexual experience – Abdominal and low back pain
- VS peak – Return to normal urination frequency
- 3-1o seconds – Nosebleeds and gum bleeds
Sexual Responses – Vaginal Discharge
Initial – Vasocongestion and Myotonia – Tingling and Itching
muscle tension – Continuation of other symptoms
Phases: THIRD TRIMESTER OF PREGNANCY
1. Excitement phase- “ Foreplay “ ● As your fetus continues to grow, preparation for the delivery of the baby should be at
- erotic stimuli increases sexual tension hand. An uncomfortable feeling would arise as weight gain continues and your false
- VS moderate labor contractions continue.
- may last from minutes to hours ● Childbirth classes and breastfeeding classes around this time are started.
● 4. Resolution phase- dangerous phase in cardiac patient ● Included below is a list of some of the changes and symptoms this final trimester:
 – Increased temperature ● VAGINA - Chadwick’s Sign
– The increased frequency of the bladder POSITIVE SIGNS OF PREGNANCY
– Swelling ● Demonstration of fetal heart rate separate from the mother
– Hair ● Fetal movement felt by the examiner
– Breast tenderness and colostrum ( 20TH – 24TH WKS AOG )
– Braxton Hicks contractions (false labor) ● Visualization of the fetus by ultrasound
PRESUMPTIVE SIGNS OF PREGNANCY – Transabdominal
● First Trimester – Transvaginal Undeniable signs
B-reast changes Nursing Interventions:
U-rinary frequency – Calculate EDC/ EDD
F-atigue – Calculate gestational age
A-menorrhea Patient Teaching:
( after 10 days) – Avoid x – ray during pregnancy, or protect abdomen as necessary.
M-orning Sickness DISCOMFORTS OF PREGNANCY
E- nlarged Uterus ( 1 ) ANKLE EDEMA
● Second Trimester ● Elevate feet when sitting or resting
C -hloasma ● Practice frequent dorsiflexion of feet
L -inea Nigra ● Avoid standing for a long period of time.
I -ncreased skin pigmentation 2 ) BACK ACHE
Q –uickening ● Practice good body mechanics
S -triae gravidarum ● Practice pelvic tilt exercise
PRESUMPTIVE SYMPTOMS ● Avoid long standing, high heels, heavy lifting, over fatigue and excessive bending or
● Subjective: reaching
– Client Need: Health promotion and maintenance ( 3 ) BREAST TENDERNESS
– Nursing Intervention: ● Wear a well – fitting supporting bra
● Instruct patient to eat dry crackers before arising ● Decrease the amount of caffeine and carbonated beverages ingested.
● Recommend frequent rest if possible ( 4 ) CONSTIPATION
– Patient Teaching: Teach patient the differences and meaning of presumptive, ● Increase fiber in the diet
probable and positive signs. ● Drink additional fluids
PROBABLE SIGNS OF PREGNANCY ● Have a regular time for bowel movement
● First Trimester ● Exercise
Chadwick’s sign (vagina) ● Use stool softeners as needed
• Goodell’s sign ( cervix ) ( 5 ) FATIGUE
• Hegar’s sign ( uterus ) ● Plan a rest period regularly
• Elevated BBT ● Have a regular bedtime routine and use extra pillow for comfort
• Positive HCG 6 ) FAINTNESS
Second Trimester ● Arise and move slowly
Ballottement ● Avoid prolonged standing
Enlarged abdomen ● Remain in a cool environment; avoid crowded places
Braxton-Hicks contractions ● Lie on left side when lying down.
PROBABLE SYMPTOMS ( ( 7 ) HEADACHE
OBSERVABLE SYMPTOMS ● Avoid eye strain
● Nursing Intervention: ● Rest with a cool cloth on the forehead
– Use first voided morning urine to identify HCG ● Report frequent and peristent headache to the doctor
● Patient Teaching: ( 8 ) HEARTBURN (PYROSIS)
– Linea nigra will disappear when pregnancy ends ● Eat small, frequent meals
– Striae may not disappear; use cream or Vitamin A daily ● Avoid spicy, greasy foods
– Chloasma is related to hormonal changes ● Refrain from lying down immediately after eating
– HCG in the urine is not diagnostic ● Use low – sodium antacids
EASY ASSOCIATION ( 9 ) HEMORRHOIDS
● UTERUS - Hegar’s Sign ● Avoid constipation and straining with BM
● CERVIX - Goodel’s Sign ● Take hot sitz bath, apply topical anesthetics, ointments, ice packs
10 ) LEG CRAMPS Prepregnancy - Occupation involving handling - Visual or hearing impaired
● Dorsiflex feet; Apply heat to affected muscle - History of drug of toxic substances (including - Pelvic inadequacy or
● Evaluate calcium to phosphorous ratio in diet. dependence raidation and anesthesia gases) malshape
( 11 ) NAUSEA (including - Environmental - Uterine incompetency,
● Avoid strong odors; drink carbonated beverages alcohol) contaminants at home position or structure
● Avoid drinking while eating - History of - Isolated - Secondary major illness
● Eat crackers, avoid spicy and greasy food, eat small frequent meals abusive - Lower economic (heart disease,
( 12 ) NASAL STUFFINESS behavior level hypertension,
● Use cool air vaporizer - Survivor of - Poor access to tuberculosis, blood
● Increase fluid intake, place moist towel on the sinuses; massage the sinuses battering transportation for care disorder, malignancy)
( 13 ) PTYALISM - History of - High altitude - Poor gynecologic or
● Use mouthwash as needed mental illness - Highly mobile obstetric history
● Chew gum or suck on hard candy. - History of poor lifestyle - History of previous poor
( 14 ) ROUND LIGAMENT PAIN coping - Poor Housing pregnancy outcome
● Avoid twisting motions, mechanisms - Lack of support - History of child with
● rise up slowly, - Cognitive people congenital anomalies
● and bend forward to relieve pain impairment - Obesity
( 15 ) SHORTNESS OF BREATH - Survivor of - Pelvic inflammatory
● Proper posture; Use pillows under head & shoulders at night childhood disease (PID)
(16) URINARY FREQUENCY sexual abuse - History of inherited
● Void at least q 2 hrs; Avoid caffeine; Practice Kegel exercise disorder
(17) LEUKORRHEA - Small stature
● Wear cotton underwear; bath daily; avoid tight panty hose - Potential of blood
(18) VARICOSE VEINS incompatibility
● Walk regularly; rest with feet elevated; avoid long standing; don’t cross legs; avoid - Younger than age 18 or
knee high stocking; wear support hosiery older than 35
DANGER SIGNS OF PREGNANCY - Cigarette smoker
● Chills and fever - Substance abuser
● Cerebral disorders (dizziness ) Pregnancy Period - Refusal of or - Subject to trauma
● Abdominal pain - Loss of neglected prenatal - Fluid or electrolyte
● Boardlike Abdomen support person care imbalance
● Blood pressure elevation - Illness of a - Exposure to - Intake of teratogen such
● Blurred Vision family member environmental as a drug
● Bleeding - Decrease teratogens - Multiple gestation
● Swelling in self-esteem - Disruptive family - A bleeding disruption
● Scotoma ( blind spot on the retina ) - Drug incident - Poor placental
● Sudden gush of fluid abuse (including - Decreased economic formation or position
RISK CONDITIONS IN PREGNANCY alcohol and cigarette support - Gestational diabetes
FACTORS THAT CATEGORIZE HIGH RISK PREGNANCIES smoking) - Conception under 1 - Nutritional deficiency of
FACTORS THAT CATEGORIZE A PREGNANCY AS HIGH RISK - Poor year from last iron, folic acid, or
Psychological Social Physical acceptance of pregnancy and protein
pregnancy pregnancy within 12 - Poor weight gain
months of the first - Pregnancy-induced
pregnancy hypertension
- Infection
- Amniotic fluid
abnormality
- Postmaturity
Labor and Delivery - Lack of support person - Hemorrhage ● Contractions occur at regular intervals
Period - Inadequate home for - Infection ● Contractions start in the back and sweep around to the abdomen, increase in intensity
- Severely infant care - Fluid and electrolyte and duration, and gradually have shortened intervals
frightened by labor - Unplanned cesarean birth imbalance ● Walking intensifies contractions
and delivery - Lack of access to - Dystocia ● “Bloody Show”
experience continued health care - Precipitous delivery ● Cervix becomes effaced and dilated
- Lack of - Lack of access to - Lacerations of cervix or ● Sedation does not stop contractions
participation due emergency personnel or vagina CHARACTERISTICS OF FALSE LABOR
to anesthesia equipment - Cephalopelvic ● Contractions occur at irregular intervals
- Separation of - disproportion ● Contractions are located chiefly in the abdomen, the intensity remains the same or is
infant at birth - Internal fetal monitoring variable, and the intervals remain long
- Lack of - Retained placenta ● Walking does not intensify contractions and often gives relief
preparation for - ● “Bloody Show” usually is not present; if present, usually brownish rather than bright
labor red
- Delivery of infant ● There are no cervical changes
who is ● Sedation tends to decrease the number of contractions
disappointing in COMPONENTS OF LABOR
some way 4 P’s OF LABOR:
- Illness in newborn 1. PASSAGEWAY – adequacy of the woman’s pelvis and birth canal in
allowing fetal decent
LABOR AND DELIVERY 2. PASSENGER – ability of the fetus to move through the passageway
INTRAPARTAL NURSING CARE MANAGEMENT 3. POWERS - frequency, duration, and strength of uterine contractions to
THEORIES OF THE ONSET OF LABOR cause complete cervical effacement and dilation
● UTERINE STRETCH - any hollow object when stretch to maximum will contract 4. PSYCHE – psychological state, available support systems, preparation for
and empties. childbirth, experiences, and coping strategies
● OXYTOCIN - labor stimulates PPG to produce oxytocin that causes uterine THE POWERS
contraction. Uterine Contractions
● PROSTAGLANDIN - labor causes release of arachidonic acid which in turn increases ● Phases:
the production of prostaglandin -> uterine contraction a. Increment or Crescendo
● AGING PLACENTA - decrease blood supply causes uterine contraction b. Acme or Apex
● PROGESTERONE DEPRIVATION – decrease causes uterine contraction c. Decrement or Decrescendo
PRELIMINARY SIGNS OF LABOR Important Aspects:
1. LIGHTENING – Duration = beginning to end of same
■ Descent of fetal presenting part; 10 – 14 days before labor onset ● Early labor = 20 – 30 secs; late: 60 – 70 secs.
2. INCREASE IN LEVEL OF ACTIVITY – Interval = end of one contraction to beginning of one
■ Due to increase epinephrine as a result of decrease progesterone ● Early labor: 40 – 45 mins.; late: 2 – 3 mins.
3. BRAXTON HICK’S CONTRACTION – Frequency = beginning to beginning
■ Painless uterine contraction; few days or weeks before labor onset ● Time 2 – 3 contractions to come up with clearer view
4. RIPENING OF THE CERVIX – Intensity = strength of contractions
■ Internal sign seen in pelvic examination; buttersoft ( softer than Goodell’s
Sign )
SIGNS OF TRUE LABOR
1. PRODUCTIVE UTERINE CONTRACTION
■ longer duration, greater intensity, regular
2. BLOODY SHOW ( PINKISH )
■ Due to expulsion of the mucus plug(operculum)mixed with ruptured
capillaries as cervix softens
3. RUPTURE OF THE MEMBRANE
■ Gush or seeping
■ Risk for intrauterine infection and cord prolapse
CHARACTERISTICS OF TRUE LABOR
STAGES OF LABOR ● Vertex: face, brow, chin
● FIRST STAGE – Breech
– Latent Phase: onset of contractions; effacement and dilation of cervix at 3 to ● Complete
4 cms ● Incomplete: frank, footling, kneeling
– Active Phase: dilation continuous from 3 to 4 to 7 cms; contractions are – Shoulder
stronger ● Transverse
– Transition Phase: cervix dilates from 8 to 10 cms; irresistible urge to push – Horizontal or perpendicular
● SECOND STAGE (EXPULSIVE STAGE)
– Cardinal Movements or Mechanisms
● Engagement
● Descent
● Flexion
● Internal Rotation
● Extension
● External Rotation (Restitution)
● Expulsion
● THIRD STAGE (PLACENTAL STAGE
● Placental Separation
● Signs of Placental Separation:
● Uterus becoming globular
● Fundus rising in the abdomen
● Lengthening of the cord
● Increased bleeding (trickle or gush)
● Placental Expulsion
FOURTH STAGE (RECOVERY AND BONDING)
– First 1 to 4 hours after birth
– Mother and newborn recover from physical process of birth
– Maternal organs undergo initial readjustment
– Newborn body systems begin to adjust to extrauterine life and stabilize
– Uterus contracts in the midline of the abdomen with the fundus midway MECHANISM OF LABOR
between the umbilicus and symphysis pubis ● Engagement
FETAL PRESENTATION AND POSITION ● Descent
● ATTITUDE ● Flexion
– degree of flexion of head, body, extremities; Complete Flexion ● Internal Rotation
● ENGAGEMENT ● Extension
– settling of the presenting part ● External Rotation
– the presenting part ( widest diameter ) has pass through the pelvic inlet ● Expulsion
● STATION
– relationship of fetal presenting part with the ischial spine of the mother
● FETAL LIE
– relationship of long axis of mother with long axis of fetus
FETAL STATION
● Relationship of the presenting part to ischial
spine
● -1: 1 cm above ischial spine
● -3: needs therapeutic rest
● 0: level of ischial spine, ENGAGEMENT
● +3, 4, 5: crowning (2nd stage of labor)

PRESENTATION/FETAL LIE
● Longitudinal
– Cephalic
NURSING CONSIDERATIONS: FIRST STAGE OF LABOR NURSING CONSIDERATIONS: RECOVERY ROOM
● Bath patient as necessary ● Maintain patient flat on bed until instructed otherwise in order to prevent dizziness
● Monitor patient’s Vital Signs, especially Blood Pressure ● Monitor patient’s vital signs, if with chills provide additional warm blanket to prevent
– If patients has the same BP 🡪 rest hypothermia
– If elevated BP 🡪 notify immediate attending physician ● Keep patient properly oxygenated
● Place patient on Nothing Per Orem (NPO) ● Give nourishment as ordered:
● Encourage mother to void – Clear liquids
● Do perineal preparation or cleansing – Full liquids
● Administer Enema (as per hospital policies) – Soft diet
– Cleanse bowel to prevent infection – Regular diet
– Place patient in Lateral Sidelying (Sims) Position, elevated enema can to FOURTH STAGE: RECOVERY AND BONDING
about 12-18 inches, insert catheter slowly and pull out slowly if with ● Maternal observations: monitor for body system (reproductive system changes,
resistance to allow water flow to rectum cardiovascular system changes, respiratory system changes, etc.) stabilization
– Clamp rectal tube if (+) contraction
– Check FHT before and after (120-160, irregular) ● Placement of the Fundus: shoulde be at the level of the umbilicus
SECOND STAGE OF LABOR – Check bladder, assist in voiding
● Fetal stage or Expulsion Stage – Check for uterine atony as this may lead to hemorrhage
● Primigravida: transfer at 10 cm dilatation – 10 to 14 days is the period of involution
● Multigravida: transfer at 7 - 8 cm dilatation ● Perineum: check for REEDA
● Lift legs simultaneously ( Lithotomy ) – Redness, Edema, Ecchymoses, Discharges, Approximation
● Bulging of perineum – best sign of delivery initiation ● Monitor vital signs every 15 minutes
● Pant and blow breathing, push with open glottis ● Pain Management
DELIVERY ● Psychological state (postpartum blues )
● Support head and remove secretions ● Bonding or Rooming-in of Baby
● Check for cord coil – Strict – 24 hours with mother
● Maintain temperature – Partial – with mother during the morning, at nursery during the afternoon
● Put on abdomen of mother to facilitate contractions ● Check for Lochia:
● Clamp cord, don’t milk, wait for the pulsation to stop the cut cord – Lochia Rubra is the dark red discharge occurring in the first 2 to 3 days
● Administration of vitamin K and tetracycline eye ointment – Lochia Serosa is pink to brownish discharge, occurring from 3 to 10 days
● Proper identification after delivery
THIRD STAGE: BIRTH TO EXPULSION OF PLACENTA (PLACENTAL STAGE) – Lochia Alba is an almost colorless to creamy yellowish discharge occurring
● First sign: fundus rises 🡪 Calkin’s sign from 10 days to 3 weeks after delivery
● Signs of placental separation
– Fundus becomes globular and rises
– Gush of blood
– Cord descends several inches out of vagina
TYPES OF PLACENTAL DELIVERY
● Shultz (Shiny)
– From center to edges
– Presents fetal side that is shiny
● Duncan (Dirty)
– from edges to center
– Presents maternal side that is beefy red and dirty
NURSING CONSIDERATIONS
● Check Placenta (cotyledons) for completeness
● Assess firmness of fundus
● Monitor patient’s blood pressure
● Administer Methergine as ordered by physician
● Administer Oxytocin as ordered by physician
● Check for laceration
● Check on patient’s Episiorrhapy for any signs of bleeding
● Do proper aftercare of equipments and delivery room after delivery