MATERNAL NEWBORN NURSING • REVIEW OF REPRODUCTIVE A&P, FETAL CONCEPTION AND DEVELOPMENT • ANTEPARTUM TERMINOLOGY • ANTEPARTUM ASSESSMENT • PHYSIOLOGICAL CHANGES IN PREGNANCY • PSYCHO-SOCIAL CHANGES IN PREGNANCY • MATERNAL NUTRITION • ASSESSMENT OF FETAL WELL BEING
MATERNAL NEWBORN NURSING. REVIEW OF REPRODUCTIVE A&P, FETAL CONCEPTION AND DEVELOPMENT ANTEPARTUM TERMINOLOGY ANTEPARTUM ASSESSMENT PHYSIOLOGICAL CHANGES IN PREGNANCY PSYCHO-SOCIAL CHANGES IN PREGNANCY MATERNAL NUTRITION ASSESSMENT OF FETAL WELL BEING. - PowerPoint PPT Presentation
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MATERNAL NEWBORN NURSING
• REVIEW OF REPRODUCTIVE A&P, FETAL CONCEPTION AND DEVELOPMENT
• ANTEPARTUM TERMINOLOGY• ANTEPARTUM ASSESSMENT• PHYSIOLOGICAL CHANGES IN PREGNANCY• PSYCHO-SOCIAL CHANGES IN PREGNANCY• MATERNAL NUTRITION• ASSESSMENT OF FETAL WELL BEING
MODULE 1 PART 1 REVIEW OF REPRODUCTIVE ANATOMY AND
PHYSIOLOGY
• REVIEW• REPRODUCTIVE A&P, FETAL
CONCEPTION & DEVELOPMENTTHIS WILL NOT BE COVERED IN THIS THIS WILL NOT BE COVERED IN THIS LECTURE—BE PREPARED TO ANSWER LECTURE—BE PREPARED TO ANSWER REVIEW QUESTIONS IN CLASSREVIEW QUESTIONS IN CLASS
THE QUIZ IN CLASS 1 WILL FOCUS THE QUIZ IN CLASS 1 WILL FOCUS ON CHANGES IN PREGNANCY AND ON CHANGES IN PREGNANCY AND TERMINOLOGYTERMINOLOGY
Review of Reproductive A&PExternal GenitalsInternal Reproductive Organs
Figure 2–13 Female reproductive cycle: interrelationships of hormones with the four phases of the uterine cycle and the two phases of the ovarian cycle in an ideal 28-day cycle.
Figure 2–14 Various stages of development of the ovarian follicles.
Figure 3–2a Sperm penetration of an ovum. The sequential steps of oocyte penetration by a sperm are depicted moving from top to bottom. Source: Scanning electron micrograph from Nilsson, L. (1990). A child is born. New York: Dell Publishing.
Figure 3–1b Each spermatogonium produces four haploid spermatozoa.
Figure 3–5 Formation of primary germ layers. A, Implantation of a 71⁄2-day blastocyst in which the cells of the embryonic disc are separated from the amnion by a fluid-filled space. The erosion of the endometrium by the syncytiotrophoblast is ongoing. B, Implantation is completed by day 9, and extraembryonic mesoderm is beginning to form a discrete layer beneath the cytotrophoblast. C, By day 16 the embryo shows all three germ layers, a yolk sac, and an allantois (an outpouching of the yolk sac that forms the structural basis of the body stalk, or umbilical cord). The cytotrophoblast and associated mesoderm have become the chorion, and chorionic villi are developing. Source: Adapted from Marieb, E. N. (1998).
Figure 3–4 During ovulation, the ovum leaves the ovary and enters the fallopian tube. Fertilization generally occurs in the outer third of the fallopian tube. Subsequent changes in the fertilized ovum from conception to implantation are depicted.
Figure 3–10 Vascular arrangement of the placenta. Arrows indicate the direction of blood flow. Maternal blood flows through the uterine arteries to the intervillous spaces of the placenta and returns through the uterine veins to maternal circulation. Fetal blood flows through the umbilical arteries into the villous capillaries of the placenta and returns through the umbilical vein to the fetal circulation.
Figure 3–7 Early development of primary embryonic membranes. At 41⁄2 weeks, the decidua capsularis (placental portion enclosing the embryo on the uterine surface) and decidua basalis (placental portion encompassing the elaborate chorionic villi and maternal endometrium) are well formed. The chorionic villi lie in blood-filled intervillous spaces within the endometrium. The amnion and yolk sac are well developed. Source: Adapted from Marieb, E. N. (1998).
Figure 3–10 Vascular arrangement of the placenta. Arrows indicate the direction of blood flow. Maternal blood flows through the uterine arteries to the intervillous spaces of the placenta and returns through the uterine veins to maternal circulation. Fetal blood flows through the umbilical arteries into the villous capillaries of the placenta and returns through the umbilical vein to the fetal circulation.
Figure 3–7 Early development of primary embryonic membranes. At 41⁄2 weeks, the decidua capsularis (placental portion enclosing the embryo on the uterine surface) and decidua basalis (placental portion encompassing the elaborate chorionic villi and maternal endometrium) are well formed. The chorionic villi lie in blood-filled intervillous spaces within the endometrium. The amnion and yolk sac are well developed. Source: Adapted from Marieb, E. N. (1998).
Figure 3–6 Endoderm differentiates to form the epithelial lining of the digestive and respiratory tracts and associated glands. Source: Adapted from Marieb, E. N. (1998).
Figure 3–12 The actual size of a human conceptus from fertilization to the early fetal stage. The embryonic stage begins in the third week after fertilization; the fetal stage begins in the ninth week. Source: Adapted from Marieb, E. N. (1998).
MODULE 1 PART 5 REVIEW QUESTIONS
REVIEW QUESTIONS• WHAT IS THE SIGNIFICANCE OF THE
ENDOMETRIAL (MUCOSAL) LAYER OF THE UTERUS?
• THE UTERUS IS MADE UP OF WHAT TYPE OF MUSCLE?
• ESTROGEN IS SECRETED BY THE_______? • PROGESTERONE IS SECRETED BY THE_______?• WHAT IS THE FUNCTION OF FSH AND LH?• DESCRIBE MEIOSIS.
REVIEW QUESTIONS
• WHERE DOES FERTILIZATION OCCUR?• THE BLASTOCYST DEVELOPS INTO THE ______.• THE TROPHOBLAST DEVELOPS INTO THE ____. • THE PLACENTA DEVELOPS FROM THE ______. • WHICH SYSTEMS/STRUCTURES DEVELOP
FROM THE MESODERM LAYER?
• NAME THREE FACTORS THAT AFFECT FETAL DEVELOPMENT.
• WHAT IS THE ROLE OF THE BROAD AND ROUND LIGAMENTS?
• WHAT IS THE UPPER PORTION OF THE UTERUS CALLED?
• WHATS CHANGES OCCUR IN THE FUNCTION OF THE OVARIES AT ABOUT THE 12- 14TH WEEK OF PREGNANCY?
• AMBIVALENCE• ACCEPTANCE• INTROVERSION• MOOD SWINGS• FEAR• CHANGES IN BODY IMAGE• ANTEPARTUM DEPRESSION?
FATHER’S RESPONSE TO PREGNANCY• CONFUSED BY PARTNER’S MOOD SWINGS• FEELS LEFT OUT• RESENTS ATTENTION GIVEN YO THE WOMAN• RESENTS CHANGES IN THEIR RELATIONSHIP• NEEDS TO RESOLVE CONFLICTS ABOUT
FATHERING
MODULE 1 PART 8 ANTEPARTUM TERMINOLOGY
GESTATION
ANTEPARTUM
INTRAPARTUM
POSTPARTUM
PRETERM LABOR
POSTTERM LABOR
• GRAVIDA
–NULLIGRAVIDA
–PRIMIGRAVIDA
–MULTIGRAVIDA
• PARA
–NULLIPARA
–PRIMIPARA
–MULTIPARA
• ABORTION: 4-20 WEEKS
• PRE-TERM: 21-39 WEEKS
• TERM: 39 WEEKS, 1 DAY- 42 WEEKS
• TPAL• T--NUMBER OF TERM PREGNANCIES
• P--NUMBER OF BIRTHS AFTER 20 WEEKS
• A—NUMBER OF ABORTIONS
• L—NUMBER OF LIVING CHILDREN
G/TPAL EXERCISES• G T P A L
• G3 1 2 0 1
• G2 0 3 1 3
• G5 2 1 3 3
• G2 0 5 0 3
MODULE 1 PART 9AANTEPARTUM PHYSICAL AND PSYCHO-SOCIAL ASSESSMENT
ANTEPARTUM PHYSICAL AND PSYCHO-SOCIAL ASSESSMENT
FINDINGSRELATED
TOPREGNANCYPHYSICAL
ASSESSMENT
ECONOMICSENVIRONMENT
SUPPORT SYSTEM
FAMILYFUNCTION
CLIENT PROFILE
EDUCATIONALNEEDS
CULTURE
RISKFACTORS
CULTURAL BELIEFS AND PRACTICE ASSESSMENT IN ANTEPARTUM PERIOD
• HOME REMEDIES• NUTRITION• ALTERNATIVE HEALTH CARE PROVIDERS • FAMILY SUPPORT• EXERCISE• SPIRITUALITY
CULTURAL CONSIDERATIONS/ASSESSMENT IN ANTEPARTUM PERIOD
• VIEW OF PREGNANCY• SELF CARE PRACTICES• PAIN• CHILDBIRTH PRACTICES• CARE OF THE NEWBORN• POST PARTUM
SIGNS OF PREGNANCY
• SUBJECTIVE (PRESUMPTIVE)
• OBJECTIVE (PROBABLE)
• DIAGNOSTIC (POSITIVE)
DUE DATE
• EDD, EDC, EDB
• NAEGLE’S RULE—SUBTRACT 3 MONTHS FROM FIRST DAY OF LAST MENSTRUAL PERIOD AND ADD 7 DAYS
• EXAMPLE: LMP OCT. 12—EDB---JULY 19
CLIENT PROFILE
CURRENT PREGNANCYPAST PREGNANCYCURRENT MEDICAL/SUGICAL HISTORYGYN HISTORYFAMILY MEDICAL HISTORYRELIGIOUS, SPIRITUAL, CULTURAL HISTORYOCCUPATIONAL HISTORYPERSONAL INFORMATION—(PSYCHOSOCIAL)
ANTEPARTUM RISK FACTORS• FACTORS RELATED TO:• ECONOMICS• ENVIRONMENT• CURRENT HEALTH STATUS/PRACTICES• AGE• NUTRITION• CHILDBIRTH HISTORY• SOCIAL ISSUES• PYSCHOLOGICAL STATUS
MODULE 1 PART 9B ANTEPARTUM PHYSICAL AND PSYCHOSOCIAL ASSESSMENT
ANTEPARTUM PHYSICAL ASSESSMENT
VS UTERUSSKIN EXTERNAL GENITALSMOUTH, EARS, NECK CERVIX, VAGINACHEST AND LUNGS ANUS AND RECTUMBREASTS LAB EVALUATIONHEARTABDOMENEXTREMITIESREFLEXESSPINE
LAB EVALUATIONS INITIAL ANTEPARTUM VISIT• SCREENING TESTS– CBC– ABO AND Rh TYPING– WBC WITH DIFFERENTIAL– FIRST TRIMESTER ANEUPLOIDY – STD SCREENING, HIV– GLUCOSE– RUBELLA TITER– HEPATITS B– SICKLE CELL– PAP SMEAR
PSYCHO-SOCIAL ANTEPARTUM ASSESSMENT
• CULTURE• PSYCHOLOGIC STATUS• EDUCATIONAL NEEDS• SUPPORT SYSTEMS• FUNCTIONING OF FAMILY• ECONOMIC STATUS• ENVIRONMENT
• VAGINAL BLEEDING• LEAKAGE OF FLUID FROM VAGINA• ABDOMINAL PAIN• TEMP > 101• DIZZINESS, BLURRING OF VISION• SEVERE HEADACHE• EDEMA OF HANDS, FACE, FEET
DANGER SIGNS OF PREGNANCY
• PERSISTENT VOMITING• MUSCULAR IRRITABILITY• EPIGASTRIC PAIN• OLIGURIA• DYSURIA• ABSENCE OF FETAL MOVEMENT
DISCOMFORTS OF PREGNANCY
• FIRST TRIMESTER–NAUSEA AND VOMITING
–URINARY FREQUENCY
–FATIGUE
–BREAST TENDERNESS
DISCOMFORTS OF PREGNANCY
–INCREASED VAGINAL DISCHARGE
–NASAL STUFFINESS & EPITAXIS
–PTYALISM
DISCOMFORTS OF PREGNANCY
• SECOND & THIRD TRIMESTER–HEARTBURN
–ANKLE EDEMA
–VARICOSE VEINS
–HEMORRHOIDS
DISCOMFORTS OF PREGNANCY
– CONSTIPATION
– BACKACHE
– LEG CRAMPS
– FAINTNESS
DISCOMFORTS OF PREGNANCY
–DYSPNEA
– FLATULENCE
–CARPAL TUNNEL SYNDROME
–DIFFICULTY SLEEPING–ROUND LIGAMENT PAIN
DISCOMFORTS OF PREGNANCY• DETERMINE WHICH SYSTEM IS RESPONSIBLE
FOR EACH OF THE DISCOMFORTS OF PREGNANCY.
• EXPLAIN HOW THE PHYSIOLOGICAL CHANGES THAT OCCUR IN EACH SYSTEM DURING PREGNANCY CAN BE RESPONSIBLE FOR THE DISCOMFORTS.
• WHAT INTERVENTIONS WOULD YOU USE TO TREAT THE DISCOMFORTS? (EBP)
SUBSEQUENT LAB EVALUATION
• HEMOGLOBIN• QUAD MARKER (15-20 WEEKS)• INDIRECT COOMBS • 50 G 1 HOUR GLUCOSE SCREEN• URINALYSIS—GYCOSURIA, PROTEINURIA• GROUP B STREP SCREENING (35-37
WEEKS)
SELF CARE PROMOTION• BATHING• EMPLOYMENT• TRAVEL• ACTIVITY, REST• FETAL ACTIVITY MONITORING• BREAST CARE• CLOTHING• BATHING
SELF CARE PROMOTION
• DENTAL CARE• IMMUNIZATIONS• SEXUAL ACTIVITY• COMPLEMENTARY & ALTERNATIVE THERAPIES• ABSTINENCE FROM ALCOHOL, TOBACCO,