Friday, December 14, 2007

PRENATAL, LABOR/ DELIVERY AND POSTPARTUM CARE

PRENATAL, LABOR/ DELIVERY AND POSTPARTUM CARE

A. STAGES OF HUMAN PRENATAL DEVELOPMENT
1. First 12-14 days – zygote
2. 15th day – 8th week – embryo
3. 8th week – time of birth – fetus

B. GERM LAYERS
1. Endoderm
2. Mesoderm
3. Ectoderm

C. NORMAL WEIGHT GAIN (20-25 lbs)
1. 1st trimester – 1.5-3 lbs
2. 2nd trimester – 10-11 lbs
3. 3rd trimester – 8-11 lbs

D. DANGER SIGNS DURING PREGNANCY
1. Vaginal bleeding
2. Persistent vomiting (hyperemesis gravidarum)
3. Chills and fever
4. Sudden escape of fluid from the vagina

E. EXERCISE DURING PREGNANCY
1. Promote comfort
2. To facilitate labor and delivery
3. To strengthen muscles so that they will revert to normal condition and functioning, quickly and efficiently following childbirth

F. BASIC PRENATAL EXERCISES
1. Basic breathing exercises
2. Contraction and relaxation of pelvic floor muscle
3. Basic pelvic rocking exercises for good posture
4. Postural education
5. Basic pelvic tilting laterally
6. Basic pelvic rotation
7. Positions
8. Muscle control and relaxation technique
9. Basic food exercises
10. Stretching and Relaxing

G. WOMAN’S EMOTIONAL RESPONSES TO PREGNANCY
1. Narcissism or self-centeredness
2. Extroversion
3. Inability to make decisions
4. Emotional liability
5. Changes in sexual desires

H. SCHEDULE OF CLINIC VISITS
1. First 7 months – once a month
2. 8th month – every other week
3. 9th month – every week

I. FOUR P’S OF LABOR
1. Power
§ Uterine contractions
§ Voluntary bearing down
§ Abdominal muscle contractions
§ Contractions of levator ani muscle
2. Passageway
3. Passenger
§ Attitude
§ Engagement
§ Position
§ Presentation and presenting part
§ station
4. Person

J. THEORIES OF LABOR ONSET
1. Uterine Stretch Theory
2. Oxytocin Stimulation Theory
3. Progesterone Deprivation Theory
4. Prostaglandin Theory
5. Theory of Aging Placenta

K. PRODROMAL SIGNS OF LABOR
1. Lightening
2. Loss of weight
3. Increased level of activity (nesting)
4. Braxton-Hick’s contractions
5. Ripening of the cervix
6. Rupture of the membranes
7. Bloody Show

L. SIGNS OF LABOR
1. Uterine contractions
2. Effacement
3. Dilatation
4. Uterine changes

M. FALSE LABOR PAINS
1. Remain irregular
2. Confined to abdomen
3. No increase in duration, frequency and intensity
4. Often disappear if the woman ambulates
5. Absent cervical changes

N. TRUE LABOR PAINS
1. May be slightly irregular to regular and predictably
2. First felt in lower back and sweep around to abdomen
3. Increasing frequency, duration and intensity
4. Continuous
5. (+) Effacement and dilatation

O. EFFECTS OF LIGHTENING
1. Shooting pains down the legs
2. Increased lordosis
3. Increased amount of vaginal discharge
4. Resurgence of a sign of pregnancy

P. CONSEQUENCES OF SPONTANEOUS RUPTURE OF MEMBRANES
1. Labor is inevitable
2. If (-) labor à need for induction
3. (+) umbilical cord compression

Q. STAGES OF LABOR
1. Dilatation
2. Complete dilatation to delivery
3. Placental stage: delivery of baby à placenta
4. Homeostasis: 1-2 hours post delivery

R. MECHANISMS OF LABOR
1. Descent
2. Flexion
3. Internal Rotation
4. Extension
5. External rotation
6. Expulsion

S. DANGER SIGNS DURING LABOR AND DELIVERY
1. Vaginal bleeding
2. Premature labor
3. Abnormal fetal presentation
4. Ruptured membranes
5. Crowning

T. TWO PHASES IN THE THIRD STAGE OF LABOR
1. Placental separation
2. Placental expulsion

U. SIGNS OF PLACENTAL SEPARATION
1. Firm and round uterus
2. Sudden gush of blood
3. Lengthening of the umbilical cord

V. LEOPOLD’S MANEUVER
1. LM1 – presentation
2. LM2 – feet and back (fetal lie)
3. LM3 – engagement
4. LM4 – attitude

W. MINOR SYMPTOMS OF PREGNANCY
1. Nausea and vomiting (increase glucose intake, dry crackers)
2. Pyrosis (small feedings, don’t lie down p.c.)
3. Constipation (increase roughage)
4. Fatigue (increase rest and sleep; good resting position)
5. Varicosities (sims position; raise legs for 15-20 minutes)
6. Muscle cramps
7. Hemorrhoids (sims; knee-chest)
8. Palpitations ( refrain sudden, rapid movements)
9. Leukorrhea (daily bath)
10. Pruritus (referred to MD)
11. Frequency of urination

X. INTERVENTIONS FOR NON CONTRACTED UTERUS
1. Massage
2. Ice compress
3. Oxytocin administration
4. Emptying of the bladder
5. Bimanual compression
6. Hysterectomy

Y. THREE LEADING CAUSES OF MATERNAL MORTALITY
1. Hemorrhage
2. Infection
3. Toxemia

Z. POSTPARTUM INFECTIONS
1. Infection of the perineum
2. Mastitis
3. Endometritis
4. Thrombophlebitis

NEWBORN CARE

A. PRINCIPLES OF NEWBORN CARE
1. Establish and maintain a patent airway
2. Maintain appropriate body temperature
3. Immediate assessment of the newborn
4. Proper identification
5. Nursery care

B. METHODS OF ESTIMATING AOG
1. Naegel’s Rule – LMP – 3 months + 7 days
2. McDonald’s Rule – fundic height / 4 = AOG in months
3. Bartholomew’s Rule – AOG based on fundic location
4. Quickening
5. FHT
6. Ultrasound
7. Assessment of newborn at birth

C. ANTHROPOMETRIC MEASUREMENTS
1. Length – 50 cm / 20 inches; 19-21.5 inches/ 47.5-53.75 cm
2. Head circumference – 33-35 cm
3. Chest circumference – 31-33 cm
4. Abdominal circumference – 31-33 cm

D. SPECIFIC NURSING ACTIONS
1. Oil bath
2. Cord dressings
3. Crede’s prophylaxis
4. Vitamin K administration
5. Weighing
6. Feeding

E. PHYSIOLOGIC WEIGHT LOSS
1. No longer under the influence of maternal hormones
2. Voids and passes out stools
3. Has limited intake
4. Has beginning difficulty establishing suckling

F. VITAL SIGNS
1. Pulse – 120-160 bpm
2. Respirations - 30-60 bpm
3. BP – 80/46 – 100/50 mm Hg

G. SKIN
1. Acrocyanosis
2. Pallor
3. Gray color
4. Jaundice
5. Harlequin sign
6. Mongolian spots
7. Lanugo
8. Desquamation
9. Petechiae
10. Milia

H. FETAL ACCESSORY STRUCTURES
1. Foramen ovale
2. Ductus Arteriosus à ligamentum arteriosum
3. Ductus Venosus à ligamentum venosum
4. Umbilical vein
5. Umbilical arteries

I. REFLEXES
1. Blink
2. Rooting
3. Sucking
4. Extrusion
5. Swallowing
6. Tonic-neck
7. Babinski
8. Landau
9. Palmar/Plantar grasp/ step in place
10. Moro

J. BREAST MILK
1. low in proteins (lactalbumin)
2. high CHO (easily digestible lactose)
3. low minerals
4. low fat
5. energy value = 20 cal/oz

K. COW’S MILK
1. high CHON (casein)
2. high fat (linoleic)
3. low CHO
4. high minerals
5. energy value – 20 cal/oz

L. COMMON HEALTH PROBLEMS
1. Constipation
2. Loose stools
3. Colic
4. Spitting up
5. Skin irritation
6. Occasional “crossed eyes”
7. Seborrheic dermatitis (cradle cap)

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