8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 185

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 285

START EVERYTHING WITH A

PRAYER

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 385

Lord I offer my life

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 285

START EVERYTHING WITH A

PRAYER

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 385

Lord I offer my life

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 385

Lord I offer my life

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 485

Antepartum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 585

Antenatal Nursing

0 Starts from conception and fetal development to the

beginning of labor

0

Encompasses all aspects of health care delivery of achildbearing individual

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 685

Pregnancy0 Maternal condition of having a

developing fetus in the body

0 Starts with fertilization and

ends with child birth on

average its duration is 38

weeks

0 also called gestation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 785

Signs amp Symptoms of

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 885

I think Irsquom pregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 985

The subjective signs

(Presumptive)0 Remember ANUBE

0 Amenorrhea

0

Nausea amp Vomiting0 Urinary frequency

0 Breast tenderness and changes

0 Excessive fatigue

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1085

Irsquom pretty

sure Irsquompregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1185

The objective signs (Probable)0 CGH

0 Hegarrsquos sign ndash softening of the

lower uterine segment

0 Goodellrsquos sign ndash softening of the

cervix

0 Chadwickrsquos sign ndash bluish

discoloration of vagina amp cervix

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1285

hellipcont

0 Ladinrsquos sign ndash softening of the uterus

0 Abdominal enlargement

0 Skin pigmentation

0 Braxton-Hicks contraction ndash intermittent contraction ofthe uterus

0 Ballottement ndash sinking and rebounding of the fetus in itssurrounding amniotic fluid in response to sudden tap onthe uterus (occurs in midpregnancy)

0 Leukorrhea ndash increase vaginal discharge

0 Quickening ndash occur bet 16th-20th week

0 Positive HCG in urine or serum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 585

Antenatal Nursing

0 Starts from conception and fetal development to the

beginning of labor

0

Encompasses all aspects of health care delivery of achildbearing individual

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 685

Pregnancy0 Maternal condition of having a

developing fetus in the body

0 Starts with fertilization and

ends with child birth on

average its duration is 38

weeks

0 also called gestation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 785

Signs amp Symptoms of

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 885

I think Irsquom pregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 985

The subjective signs

(Presumptive)0 Remember ANUBE

0 Amenorrhea

0

Nausea amp Vomiting0 Urinary frequency

0 Breast tenderness and changes

0 Excessive fatigue

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1085

Irsquom pretty

sure Irsquompregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1185

The objective signs (Probable)0 CGH

0 Hegarrsquos sign ndash softening of the

lower uterine segment

0 Goodellrsquos sign ndash softening of the

cervix

0 Chadwickrsquos sign ndash bluish

discoloration of vagina amp cervix

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1285

hellipcont

0 Ladinrsquos sign ndash softening of the uterus

0 Abdominal enlargement

0 Skin pigmentation

0 Braxton-Hicks contraction ndash intermittent contraction ofthe uterus

0 Ballottement ndash sinking and rebounding of the fetus in itssurrounding amniotic fluid in response to sudden tap onthe uterus (occurs in midpregnancy)

0 Leukorrhea ndash increase vaginal discharge

0 Quickening ndash occur bet 16th-20th week

0 Positive HCG in urine or serum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 685

Pregnancy0 Maternal condition of having a

developing fetus in the body

0 Starts with fertilization and

ends with child birth on

average its duration is 38

weeks

0 also called gestation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 785

Signs amp Symptoms of

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 885

I think Irsquom pregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 985

The subjective signs

(Presumptive)0 Remember ANUBE

0 Amenorrhea

0

Nausea amp Vomiting0 Urinary frequency

0 Breast tenderness and changes

0 Excessive fatigue

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1085

Irsquom pretty

sure Irsquompregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1185

The objective signs (Probable)0 CGH

0 Hegarrsquos sign ndash softening of the

lower uterine segment

0 Goodellrsquos sign ndash softening of the

cervix

0 Chadwickrsquos sign ndash bluish

discoloration of vagina amp cervix

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1285

hellipcont

0 Ladinrsquos sign ndash softening of the uterus

0 Abdominal enlargement

0 Skin pigmentation

0 Braxton-Hicks contraction ndash intermittent contraction ofthe uterus

0 Ballottement ndash sinking and rebounding of the fetus in itssurrounding amniotic fluid in response to sudden tap onthe uterus (occurs in midpregnancy)

0 Leukorrhea ndash increase vaginal discharge

0 Quickening ndash occur bet 16th-20th week

0 Positive HCG in urine or serum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 785

Signs amp Symptoms of

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 885

I think Irsquom pregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 985

The subjective signs

(Presumptive)0 Remember ANUBE

0 Amenorrhea

0

Nausea amp Vomiting0 Urinary frequency

0 Breast tenderness and changes

0 Excessive fatigue

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1085

Irsquom pretty

sure Irsquompregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1185

The objective signs (Probable)0 CGH

0 Hegarrsquos sign ndash softening of the

lower uterine segment

0 Goodellrsquos sign ndash softening of the

cervix

0 Chadwickrsquos sign ndash bluish

discoloration of vagina amp cervix

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1285

hellipcont

0 Ladinrsquos sign ndash softening of the uterus

0 Abdominal enlargement

0 Skin pigmentation

0 Braxton-Hicks contraction ndash intermittent contraction ofthe uterus

0 Ballottement ndash sinking and rebounding of the fetus in itssurrounding amniotic fluid in response to sudden tap onthe uterus (occurs in midpregnancy)

0 Leukorrhea ndash increase vaginal discharge

0 Quickening ndash occur bet 16th-20th week

0 Positive HCG in urine or serum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 885

I think Irsquom pregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 985

The subjective signs

(Presumptive)0 Remember ANUBE

0 Amenorrhea

0

Nausea amp Vomiting0 Urinary frequency

0 Breast tenderness and changes

0 Excessive fatigue

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1085

Irsquom pretty

sure Irsquompregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1185

The objective signs (Probable)0 CGH

0 Hegarrsquos sign ndash softening of the

lower uterine segment

0 Goodellrsquos sign ndash softening of the

cervix

0 Chadwickrsquos sign ndash bluish

discoloration of vagina amp cervix

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1285

hellipcont

0 Ladinrsquos sign ndash softening of the uterus

0 Abdominal enlargement

0 Skin pigmentation

0 Braxton-Hicks contraction ndash intermittent contraction ofthe uterus

0 Ballottement ndash sinking and rebounding of the fetus in itssurrounding amniotic fluid in response to sudden tap onthe uterus (occurs in midpregnancy)

0 Leukorrhea ndash increase vaginal discharge

0 Quickening ndash occur bet 16th-20th week

0 Positive HCG in urine or serum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 985

The subjective signs

(Presumptive)0 Remember ANUBE

0 Amenorrhea

0

Nausea amp Vomiting0 Urinary frequency

0 Breast tenderness and changes

0 Excessive fatigue

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1085

Irsquom pretty

sure Irsquompregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1185

The objective signs (Probable)0 CGH

0 Hegarrsquos sign ndash softening of the

lower uterine segment

0 Goodellrsquos sign ndash softening of the

cervix

0 Chadwickrsquos sign ndash bluish

discoloration of vagina amp cervix

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1285

hellipcont

0 Ladinrsquos sign ndash softening of the uterus

0 Abdominal enlargement

0 Skin pigmentation

0 Braxton-Hicks contraction ndash intermittent contraction ofthe uterus

0 Ballottement ndash sinking and rebounding of the fetus in itssurrounding amniotic fluid in response to sudden tap onthe uterus (occurs in midpregnancy)

0 Leukorrhea ndash increase vaginal discharge

0 Quickening ndash occur bet 16th-20th week

0 Positive HCG in urine or serum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1085

Irsquom pretty

sure Irsquompregnant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1185

The objective signs (Probable)0 CGH

0 Hegarrsquos sign ndash softening of the

lower uterine segment

0 Goodellrsquos sign ndash softening of the

cervix

0 Chadwickrsquos sign ndash bluish

discoloration of vagina amp cervix

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1285

hellipcont

0 Ladinrsquos sign ndash softening of the uterus

0 Abdominal enlargement

0 Skin pigmentation

0 Braxton-Hicks contraction ndash intermittent contraction ofthe uterus

0 Ballottement ndash sinking and rebounding of the fetus in itssurrounding amniotic fluid in response to sudden tap onthe uterus (occurs in midpregnancy)

0 Leukorrhea ndash increase vaginal discharge

0 Quickening ndash occur bet 16th-20th week

0 Positive HCG in urine or serum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1185

The objective signs (Probable)0 CGH

0 Hegarrsquos sign ndash softening of the

lower uterine segment

0 Goodellrsquos sign ndash softening of the

cervix

0 Chadwickrsquos sign ndash bluish

discoloration of vagina amp cervix

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1285

hellipcont

0 Ladinrsquos sign ndash softening of the uterus

0 Abdominal enlargement

0 Skin pigmentation

0 Braxton-Hicks contraction ndash intermittent contraction ofthe uterus

0 Ballottement ndash sinking and rebounding of the fetus in itssurrounding amniotic fluid in response to sudden tap onthe uterus (occurs in midpregnancy)

0 Leukorrhea ndash increase vaginal discharge

0 Quickening ndash occur bet 16th-20th week

0 Positive HCG in urine or serum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1285

hellipcont

0 Ladinrsquos sign ndash softening of the uterus

0 Abdominal enlargement

0 Skin pigmentation

0 Braxton-Hicks contraction ndash intermittent contraction ofthe uterus

0 Ballottement ndash sinking and rebounding of the fetus in itssurrounding amniotic fluid in response to sudden tap onthe uterus (occurs in midpregnancy)

0 Leukorrhea ndash increase vaginal discharge

0 Quickening ndash occur bet 16th-20th week

0 Positive HCG in urine or serum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1385

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1485

Diagnostic signs (Positive)0 Fetal heart beat

0 10th-12th week gestation heard

through doppler ultrasound

0 18th-20th week gestation heard

through fetoscope0 Fetal movement (felt by the

examiner)

0 Positive Fetal Ultrasound

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1585

Biophysical Changes in

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1685

Reproductive system

0 Endocervical glands secrete thick mucus that forms

plug or operculum (a part that serves as a cover)

0

Increase vaginal vascularization vaginal dischargetends to be thick white and acidic

0 Breast size increases nipple and areola become

darker

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1785

Respiratory system

0 Displacement of diaphragm causes shortness of

breath

0

Nasal stuffiness and epistaxis are common due toedema and vascular congestion induced by increased

estrogen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1885

Cardiovascular system

0 Heart displaced upward to the left and forward

0 Blood volume increases by 30-50 RBC volume

increases by 20-30 hematocrit decreases by 7causing physiologic anemia

0 Pulse rate increases by 10-15 beats per minute

0 Supine hypotensive syndrome occurs during the

second trimester

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 1985

Gastrointestinal System

0 Nausea and vomiting are common during the first

trimester

0

Ptyalism occurs heartburn and flatulence often occurdue to reduction in gastric acidity growing uterus and

smooth muscle relaxation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2085

Urinary System

0 Frequency of urination occurs on the first and third

trimester due to enlargement and compression of the

gravid uterus

0 Woman is at risk for glucosuria

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2185

Integumentary system

0 Pigmentation increases in the nipple areola vulva

perianal area and linea alba

0

Facial chloasma develops0 Striae common in the abdomen

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2285

Skeletal System

0 Relaxation of pubic joints during pregnancy

0 Lumbosacral curve increases producing low back pain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2385

Endocrine system0 Rise in T4 and 25 increase in basal metabolic rate

0 Anterior pituitary prolactin released for lactation

0 Posterior pituitary releases oxytocin (uterine contraction)

and vasopressin (antidiuretic and vasoconstriction effect)0 Increased insulin production

0 Hormones of pregnancy

0 Human chorionic gonadotropin

0 Human placental lactogen0 Estrogen

0 Progesterone

0 Relaxin

P Di f t d R li f

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2485

Pregnancy Discomfort and Relief

Measures

iscomfort Relief Measure

Morning sickness gtEat dry cracker 30 min before getting up

gtDrink adequate fluids bet Meals

gtAvoid spicy highly seasoned amp fatty foods

gtSmall frequent meals ndash avoid overeating

Heartburn gtBend at knees when picking up things

gtRemain upright 3-4 hours after eating

gtTake antacids as ordered

gtNo sodium bicarbonate exacerbate heartburn

Flatulence gtEat small frequent meals

gtAvoid gas-forming foods

Frequency of

urination

gtIncrease fluids to replace losses except at bedtime NOCTURIA

gtPractice regular voiding

gtPractice frequent washing front to back

gtReport any burning sensation dysuria cloudy urine or tea-colored

urine

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2585

iscomfort Relief Measure

Fatigue gtAdequate rest

gtPractice good body mechanics

gtReport increase fatigue ndash a danger sign HEART DISEASE

onstipation gtIncrease fluid intake

gtIncrease roughage

gtExercise (walking is best recommended)

gtDrink warm water in the morning

Hemorrhoids gtAvoid constipation and other forms of straininggtPromote comfort sitz bath warm compresses

gtReinsert hemorrhoids upon APrsquos recommendation

Faintness gtAvoid sudden change in position

gt2nd-3rd trimester avoid supine position

gtGradually arise from bedgtBest position Left lateral position in bed

Leg cramps gtAdequate calcium intake Calcium Phosphorus imbalance=leg

cramps

gtAvoid prolonged standingsitting

gtExtend and dorsiflex foot for relief

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2685

iscomfort Relief

Varicose veins gtWear elastic compression stockings

gtFrequently elevate legs

Backache gtMaintain good posturegtWear low-moderate-height heels

gtAvoid prolonged standing

gtPelvic rocking exercise and tailor sitting are advised

gtUse supportive mattress

Pedal edema gtElevate legs frequentlygtAvoid prolonged standing

gtReport swelling of hands and face

Shortness of

breath

gtMaintain good posture

gtAvoid fatigue

gtElevate head avoid supinegtAvoid constricting bra and other tight clothes

gtReport increasing dyspnea with minimal activity or dyspnea

prior to 36 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2785

Psychological Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2885

First Trimester

0 Denoted by ambivalence

0 Focus Bodily changes

0Developmental task to accept the biological facts ofpregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 2985

Second Trimester

0 The mother feels well and happy and fantasizes about

the baby

0 Focus self and growth and development of fetus

0 Developmental task accepts the growing fetus as

part of her

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3085

Third Trimester

0 The personal identification of the appearance of the

baby

0 Focus baby and delivery and responsible parenthood

0 Developmental task preparation for childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3185

Antepartal Care

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3285

A Health History ndash GTPALM

B Prenatal visits

gtPhilippine DOH Guideline

80 of pregnant woman should have at least 5 prenatal visits

gt1st Trimester monthly

gt2nd Trimester twice a month

gt3rd Trimester 4x a month

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3385

Obstetric History (GTPALM)

0 1 ldquoThis is my first pregnancy Irsquom on my 27th week I havenot been pregnant beforerdquo

0 2 ldquoI am on my 43rd week of pregnancy My eldest child who

is now 2 years old was born at 40 weeks and my youngestwho is now 1 year old was born at 36 weeksrdquo

0 3 ldquoI had twins who were born premature and I am notpregnant right nowrdquo

0 4 ldquoI have a child who was born full term and healthy and

another who died at birth at 39 weeksrdquo 0 5 ldquoI was pregnant but lost my baby at 16 weeks and have

not been pregnant againrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3485

Estimates in Pregnancy

0 Age of Gestation

0 McDonaldrsquos Rule

0 Bartholomewrsquos Rule

0 Estimated Fetal weight

0 Johnsonrsquos Rule

0 Estimated Fetal length

0Haasersquos Rule

0 Expected Date of Confinement (EDC)

0 Naegelersquos Rule

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3585

Calculate for EDC and AOG

0 LMP June 5

0 LMP January 3

0LMP September 19 Fundic Height 26 cm

0 LMP October 20 2008 FH 28cm

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3685

Diagnostic Tests

(DOH Standards)

0 Urinalysis

0 Blood tests

0 CBC ndash to detect anemia infection and assess clotting

0 Blood typing ndash det Blood type ro RhBlood incompatibility0 Rubella titer

0 Hepatitis B ndash if (+) for HBsAg (Hepatic antibody surfaceantigen)

0 HIV testing

0 Syphilis screening0 Cervical smear

0 FHR amp Fundic height

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3785

Health Promotion During

Pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3885

Bathing

0 Daily bathing ndash Due to increased sweating and vaginal

discharge

0 Contraindicated douching

0 Wash breasts with clear tap water ndash to remove

colostrum secretion if present

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 3985

Dressing

0 Avoid constricting clothes

0 Wear low-heeled shoes

0

Wear supportive bra

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4085

Sleep

0 Take siestas if able

0 Have rest periods during the day

0

6-8 hours of sleep

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4185

Travel

0 Early pregnancy okay

0 Late pregnancy have rest periods during long trips

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4285

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4385

Sexual Activity

0 No restrictions unless with history of preterm labor or

history of spontaneous miscarriage

0 Less desire for coitus is common

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4485

Employment

0 Decrease physical strain long periods of standing or

having to maintain body balance

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4585

Dental Care

0 Good brushing habits

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4685

Nutritional Needs

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4785

Expected weight gain

0 Normal weight gain (optimal is 25-35 lbs)

0 1st trimester 1 lb a month

0 2nd trimester 1 lb a week

0 3rd trimester 1 lb a week

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4885

Nutritional Requirements0 Calories additional 300 kcal (Mother 2200 fetus 300

total 2500 daily)

0 Carbohydrates promote growth of fetus sources ndash dairy

product veg fruits grains

0 Proteins increase maternal tissue to support fetus 60gday

0 Fats source of energy 30 of caloric intake

0 Minerals For mineralization of fetal teeth and bones Candash

1000mgday Phosphorusndash700mgday

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 4985

Nutritional Requirements

0 Iodine for thyroid function 220mcgday

0 Sodium for proper metabolism amp fluid balance

0 Magnesium cellular metabolism 350mgday

0 Iron 30mg taken with vit C

0 Folic Acid needed for RBC formation sources fruitsamp vegetable DOH 2 tabsday

0 Zinc essential for fetal growth 11mgday

0 Lactating 12mgday0 Sources meat shellfish poultry legumes and

wholegrain

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5085

Evaluation for Fetal Well-Being

0 UTZ

0 Chorionic villi sampling

0

Amniocentesis0 Percutaneous umbilical blood sampling

0 Maternal serum alpha-fetoprotein

0 Daily fetal movement

0 Non-stress test0 Contraction stress test

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5185

Intra Partum Period

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5285

Theories of Labor

0 Uterine Stretch Theory

0 Oxytocin Theory

0

Progesterone deprivation theory0 Prostaglandin theory

0 Theory of Aging placenta

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5385

Preliminary signs of Labor

0 Lightening

0 Increased activity level

0

Braxton-Hicks contraction0 Ripening of the cervix

0 Rapture of Bag of water

0 Show

0 Progressive Fetal Descent

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5485

Quick Assessment

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5585

Status of Membrane

0 If ruptured ndash assess with nitrazine paper or fern test

0 Danger of infection if ruptured for more than 24 hours

0 FHR Stat and 10 minutes later to check for prolapsed

cord0 CHECK

0 COLOR

0 NORMAL CLEAR

0 YELLOW PRESENCE OF BILIRUBIN OR RHABOINCOMPATIBILITY

0 GREEN MECONIUM-STAINED = FETAL HYPOXIA PORTWINE = ABRUPTIO PLACENTA

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5685

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5785

Degree of Descent

0 Engagement ndash widest diameter of presenting part has

passed through pelvic inlet

0 Station ndash relationship of presenting part to ischial

spine

0 FLOATING ndash presenting part above inlet

0 STATION -5 ndash presenting part at the inlet

0 STATION 0 ndash presenting part at ischial spine

0 STATION +4 ndash presenting part at the outlet

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5885

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 5985

Onset of Labor

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6085

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6185

Methods of Labor Stimulation

0 Breast Stimulation

0 Amniotomy

0 Oxytocin Administration

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6285

Stages of Labor

0 First Stage ndash begins with regular rhythmic

contractions ends with complete effacement and

dilatation (10cm)

0 Latent ndash 0 to 4cm

0 Active ndash 4 to 8 cm

0 Transitional ndash 9 to 10 cm

0 Second Stage ndash begins with complete dilatation and

ends with birth of infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6385

Mechanism of Labor

E -Engagement

D -Descent

F -Flexion

I -Internal RotationER -External Rotation

E - Expulsion

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6485

Stages of Labor cont hellip

0 Third Stage ndash begins with birth of the infant and ends

with the expulsion of the placenta

0 Fourth Stage ndash begins with the expulsion of placenta

and ends when maternal status is stable usually 1-2

hours postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6585

Operative Obstetrics

0 Episiotomy ndash incision of the perineum to facilitate

birth of the infant

0 Types

0 Midline

0 Mediolateral

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6685

Pharmacologic Pain Relief

0 Narcotic Analgesics

0 Regional anesthesia

0 Epidural Anesthesia

0 Spinal Anesthesia

0 Local Anesthesia

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6785

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6885

Definition

0 Uterus returns to non-pregnant size and shape called

involution

0 Contraction (afterpains) shortens muscles closes

venous sinuses and restores normal tone

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 6985

Post partum Assessment

BUBBLES-HE

0 B - Breast

0 U - Uterus

0 B - Bladder distention

0 B - Bowel movement0 L - Lochia

0 E - Episiotomy site

0 S - Sanitation and surroundings

0 H ndash Homanrsquos sign

0 E ndash Emotional status is ldquodistressedrdquo

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7085

Essential Objectives for

Postpartum Period0 Promote uterine involution

0 Promote successful breastfeeding

0 Prevent common discomfort of puerperium

0 Provide psychological support

0 Prevent complication

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7185

Fundic Height

0 After birth ndash at umbilicus

0 Day 1 (1st 12 hours) ndash one finger breath above

umbilicus

0 Descends by one finger breath daily until day 10

0 Day 10 ndash below symphysis pubis non palpable

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7285

Lochia

0 Is the sloughing of deciduas and blood and formation

of new endometrium occurs for 4 to 6 weeks until

placental site is healed

0 Day 1 to 3 ndash Rubra

0 Day 3 to 7 ndash Serosa

0 Day 10 ndash alba

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7385

Maternal Physiologic

Adaptations

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7485

Reproductive System

0 Uterus returns to normal size through a gradual

process of involution

0 Cervix returns to prepregnant state by week 6 and

gradually closes

0 Ovarian function returns and vagina returns to

normal by 6 to 8 weeks but remains a bit larger before

pregnancy

0 Perineum is edematous for 1 to 2 days but complete

healing of episiotomy takes 4 to 6 weeks

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7585

Cardiovascular System

0 Cardiac output returns to non-pregnant values within

4 to 6 weeks

0 Coagulation factors tend to remain elevated in the

early postpartum

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7685

Urinary System

0 Difficulty urinating occurs due to anesthesia

lacerations or swelling of the perineum

0 Post partum diuresis occurs within 12 hours after

childbirth

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7785

GIT Adaptation

0 GIT system returns rapidly to normal due to decline in

progesterone

0 Bowel tone remains slow for several days causing

constipation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7885

Respiratory System

0 Relief of discomforts associated with pregnancy

0 Respiratory rate returns to normal

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 7985

Integumentary System

0 Darkened pigmentations gradually fades

0 Striae gravidarum gradually fades to silvery lines

0 Profuse diaphoresis occurs reducing fluid retained in

pregnancy

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8085

Endocrine System

0 Levels of circulating estrogen and progesterone drop

quickly

0 Other hormones (HCG HPL) decline rapidly after

birth

0 Prolactin remains elevated ndash breastfeeding

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8185

Maternal Psychological

Adaptation

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8285

Taking in

0 24-48 hours

0 Client sleeps depends on others to meet her needs

and relives the birth process

0 Characterized by dependent behavior

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8385

Taking hold

0 Characterized by dependent and interdependent

behavior

0 Starts on the 2nd to 3rd day postpartum up to several

weeks

0 Client concerned with her health and the infant

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8485

Letting go

0 Occurs later in the post partum period

0 Assumes responsibility and care for the newborn and

assumes the parental role

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End

8122019 MCN day 2

httpslidepdfcomreaderfullmcn-day-2 8585

End