MATERNAL NURSING(OB)
MCN -
- Traditionally refers to care of women
during pregnancy Birth and postpartum
as well as the care of infants Children
and adolescents. Specifically tasked
complexities in health care has nurses
to be maternal and women’s health care
practitioners, nurse and midwives etc.
OBSTETRICS – Science that deals with childbirth
- it deals with durationPregnancy 38-42
weeksLabor & Delivery 20 hoursPuerperium 6-8 weeks
- It deals with 2 clients1. mother2. fetus
Menstrual Disorders Infertility Contraception/ Family Planning Menopause
The best managed care principles value a comprehensive approach that focus on:
*Preventionex: mammograms, SBE, cervicacancer, screening, cervical vaccines, prenatal care, smoking cessation programs, healthy lifestyle, food choices etc.
*Early Intervention
*Continuity of Care
Vagina – connects external to internal reproductive organ- It is a tube with rugae, distensible- Copulation and passage way- 3-4 inches long- Acidic, due to its normal flora- Ph – 4-5- average
Internal Reproductive Organsp.47 Fig. 3 - 1
Ovary - Cortex, medulla ovulation(4cm long) endocrine
Uterus - Fundusmenstruation
(3X2X1) Corpus gestationCervix
Fallofian - InfundiberlumTubes Ampulla Fertilization4 inches Intramus Passageway
Interstitial
UTERUS- Pear shaped- 3 Layers
1. endometrum2. myometrum3. perimetrium
- 50-60gms weight- Antenor rectum- Posterior to the bladder- Ligaments
- Broad, Cardinal, uterosacral
- Ovarian cycle Follicular maturation
of follicles Intral ovulation
- Endometrial Cycle ProliferativeSecretorymenstrual
Monthly shedding of the uterine lining Ave onset =12years – menarche Ave duration =50-52 years- menopause Ave amount =50ml (30-80ml) Ave cycle =28 days Menstrual blood consists of endometrial
cells, blood, mucus unfertilized ovum
Menorrhagia Dysmenorrhea Amenorrhea menopause
Organs Hormones
Functions
BrainHypothalamus GnRH -stimulates the APG
to secrete gonodo- trophic Hormones
BrainAPG FSH -Responsible for
maturation of Follicles
Ovary Estrogen
-Responsible for*development of ducts of the breasts*spinnbarkeit secretions
Organs Hormones Functions
Uterus Estrogen Responsible for*proliferation of the endometrial glands*endometrium increases in thickness Contracts uterus
BrainAPG LH Responsible for the
rupture of the follicle
Ovary Progesteron
-Responsible for development of the Acini cells of the breast-thick mucus secretion *relaxes the uterus
Organs Hormones
Functions
Uterus Progesterone
Responsible for secretory phase *Endometrium becomes more thickened, more vascular and glandular*Preparedness for implantation
Produced by the endometrium Technically not a hormone because they
are produced by tissues rather than special glands
Play a role in rupturing the grafian follicle
Large amount of prostaglandins are found in the menstrual blood
Found to have a contracting effect on the uterus
Ovulation occurs 14 days in a 28 day cycle
To get the approximate ovulation day, subtact 14 from the cycleEx. Cycle is d32 days – 14 = 18th day
WOMAN MAN
One ovum Millions of sperms
22 chromosomes Around 200-300M to effect fertilization, but only one to fertilized the ovum
And X sex chromosome
22 chromosomes and Y sex chromosome
24 hours viability 72 hours viability
Fertilization takes place in the ampulla of the fallopian tube
Union of sperm and ovum forms a zygote (46 chromosomes)
Zygote continues to form a MORUL (16cells)
Morula – Blastocys Inner cell mass
Embryo ammion
Outer cell Mass
trophoblast
Chorionic Villi
Decidua Basalis
PLACENTA Implantation occurs 7 to 10 days after
conception
Organ of metabolic and nutrient exchange between the embryonic and maternal circulation – begins 3rd week of embryonic development
Weight – 400 to 600gms
Diameter – 15 to 20 cm (8in)
Average: 1 inch thick
Maternal Fetal
Cotyledons Membranes
Chorion amnion
1. Respiratory2. Nutritive3. Excretory4. Barrier – Bacteria, Virus5. Endocrine
- HCG, HPL, Estrogen & Progesterone
Functions:
Acts as a cushion to protect against mechanical injury
Maintains a constant temperature Acts as a nudge during labor
Ph is alkaline and contains L,S, bilirubin, vernix, Lanugo, epithelial cells, albumin
After 20 weeks, ranges between 700-800ml
Fetus contributes to volume of amniotic fluid by excreting urine
Fetus swallows up to 600ml every 24 hours and about 400ml flows out of fetal lungs each day
Umbilical vein LiverInferior Vena Cava
thru Ductus Venosus
Right Atrium Foramen Ovale left ventricleAorta
From the superior vena cava right atrium
right ventricle pulmonary arteryductus Enterrosins Aortaby passing the lungs
4 weeks – Heart begins to beat 8 weeks – all body organs are formed 8-12 weeks – FHB- heard by doppler 16 weeks – Sex can be seen 20 weeks – FHB – heard by stethoscope
- quickening- baby has patterns of sleep,
sucking, kicking- vernix and lanugo are
present
24 weeks – Fetal respiratory movements begin
28 weeks – Eyes begin to open and close
- Head hair, eyebrows and eyelashes are present
surfactant is formed32 weeks – Subcutaneous fat
- Fingernails and toenails-Descend of testes begins
38 weeks – Term baby
Uterus non-pregnant – 60gms pregnant -
1000gms capacity - 10ml -5000ccHypertrophy (Largely)Hyperpalasia (Limited)Stimulated by E and P
Braxton Hicks – starting 4th month * stimulates movement of blood thru the
spaces of the placentaCervix
*Goodells*Chadwicks
- higher glandular cell glands leading to leukorrhea
OVARIES
Cease to function
Corpus luteum covers 1/3 of ovary and is maintained by HCG which will persist and produce hormones until placenta takes over
VAGINA
Hypertrophy
Hyperplasia
Vascularization
Results in:
Thickening of mucosa
Loosened connective tissue
Higher vaginal secretions (thick, white, acidic Ph 3.5 to 6.00)
Chadwick’s SX
BREASTS
Higher in size
Nipples erectile
Pigmented areola
Montgomary tubercles
Colostrum-may be present (yellowish, AB rich)
RESPIRATORY SYSTEMSlight hypervilationSlight increase in RRDiaphragm is elevated due to enlarging uterus
Breathing may become thoracic than abdominal
Nasal stuffiness and congestionEpistaxis may occur
CARDIOVASCULAR SYSTEM
Heart is pushed upward and to the left
Systolic murmur cab be heard in most pregnant women
Blood Volume progressively higher to about 40-50% above non-pregnant level.
Cardiac output higher and peaks 20-24 weeks
CARDIOVASCULAR SYSTEM
BP may decrease especially 2nd trimester and returns to its prepregnant level at term.
Uterine pressure on the vanal cava when the woman is supine results in supine hypotensive syndrome.
CARDIOVASCULAR SYSTEM
Total RBC volume higher by 18%-30%
Plasma volume increase is 50% but HCT lower slightly, which causes physiologic anemia of pregnancy
Higher WBC production
Fibrinogen higher by as much as 50%
GASTROINTESTINAL SYSTEM
N and V (HCG effect)
Ptayalism
Heart burn
Gastric emptying time is delayed leading to bloating and constipation
hemorrhoids
URINARY TRACT
Higher urinary frequency due to growing uterus
Glomerular Filtration Rate(GFR) higher by as much as 50%
Glycosuria is common
Amino Acids and water soluble vitamins are excreted in greater amounts
SKIN AND HAIR
Higher Pigmentation – areola, nipples, vulva, perianal area, linea alba
Chloasma
Striae or stretch mark
Sweat and sebaceous glands are hyperactive
MUSCULOSKELETAL SYSTEM
Sacroiliac, sacrococcygeal and pubic joints of the pelvis relax – (waddling gait)
Postural changes (lordosis)
CENTRAL NERVOUS SYSTEM
Sleep problems
Mood swings
Depression
PICA
Most metabolic functions
accelerate during pregnancy in
support to the additional demands
of the growing fetus, the mother’s
tissue replacement needs and in
preparation to labor and lactation.
Normal =25-30 lbs. =11-13 kg.
Weight Gain Distribution-5kg.(11lbs) -Fetus, placenta AF- .9kg(2lbs) -uterus-1.8kg(4lbs) -Blood volume-1.4kg(3lbs) -Breasts-2.3-4.5kg -Maternal stores
(5-10lbs.)
Braxton Hicks Nausea & Vomitin
FAB Ballotement
Chadwick’s Pregnancy Test
Skin Changes Amenorrhea
Breast enlargement
UTZ visualization
Hegar’s nsx Breast tenderness
According to Reva Runin (1984) there are tasks that a woman must accomplish to incorporate the maternal role successfully into her being.
1.Ensuring a safe passage throughout pregnancy and birth
*Participation in positive self care activities related to diet, exercise and over-all well being
2. Seeking acceptance of infant by others
3. Seeking acceptance of self in maternal role to infant (binding in)
*mother acknowledges fetus as a separate being w/in her – wit her experience of quickening
4. Learning to give of oneself * what must be given up to assume new role
Ambivalence- conflicting feelings, considered normal
Introversion- focusing on oneself-common during early pregnancy
- woman becomes passive to her family and friends
Acceptance - generally, wnd trimester feeling
Mood scrimp - feels, great joy, cry, disbelief etc.
Promotion of the health and well being of a woman and her partner before pregnancy.
GOAL:Identify any areas such as health problems, lifestyle habits or other concerns that might unfavorably affect pregnancy.
GOAL:Healthy mother for a healthy baby Frequency.
1-7 months = monthly
8 months = 2x moth
9 months = weekly
TERMS:
Gravida - # of pregnancy regardless of outcome
Para - # of pregnancy that has reached viability
Multigravida - a woman who has never been pregnant
OB Scoring - GP (TPAL)
Example:
Juanita is pregnant and visits you at the PNC. She had one ectopic pregnancy at 8 weeks. She has one baby born at 39 weeks and one born at 32 weeks which is a set of twins. What is her OB Score?
Answer: G4P2 T P A L 1 1 1 3
DATA – - Age, G, P, AOG- OB HX- Medical Hx
P.E.- Vital signs
- Weight and Height
- Head to toes Assessment *Head, Breast, Abdomen, Genitals, Extremities, IE*FH and Leopold’s Maneuver
Laboratory Test
- Urine
- Blood
- Pap smear - negative, organisms, presence of squamous cells or glandular cell- may favor neoplastic cells.
Weight – 25 lbs
BP
Urine testing for preotein, glucose and albumin
FH measurement
F Movement
FHR
- A procedure that is performed to determine presentation, position and lie.
First Maneuver = To determine presentation
2nd Maneuver = To determine position
3rd Maneuver = To confirm presentation and Engagement
4th Maneuver = To determine attitude
Hygiene of Pregnancy
Minor Discomforts
Danger Signs
Teratogens
Exercises
Nutrition
Nutrient
NP Present Lactation
Calories 2,200 2,500 2,700
Protein 60 gms 80 gms 80 gms
Folate 400 mcg 600 mcg 500 mcg
Iron 18mg 27mg 9mg
Calcium 1000g 1000g 1000g