DEC 2012 NLE TIPS MCHN

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  • 1. WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESSPART 2: MATERNAL AND CHILD HEALTH NURSINGA. Pregnancy  SHOULD REFRAIN FROM  Ovum: From ovulation to fertilization SEXUAL INTERCOURSE  Zygote: From fertilization to implantation AND PHYSICAL ACTIVITY  Embryo: From implantation to 5-8 weeks. FOR 48 hours.  Fetus:From 5-8 weeks until term  A small amount of spotting is normal for theLength of Pregnancy 1st 24-48 hours. 267-280 days 38-42 weeks (ave.40 weeks) ULTRASOUND  Done 18-40 weeks for 9 calendar months fetal abnormalities. 10 lunar months Use of sound and  Best Test for ECTOPIC 3 trimester returning echo PREGNANCYFirst Trimester: Period of Organogenesis patterns to identify  Full BladderSecond Trimester: Most comfortable for mother intrabody structures.  Use to locate the precise with continued fetal growth. location of the fetus andThird Trimester: Period of rapid fetal growth its membrane during CVS bec. of rapid deposition of fats and amniocentesis iron and calcium AMNIOCENTESIS  Possible after the 14th week.B. Signs of Pregnancy Aspiration of amniotic  The client should be fluid for examination. supine during the Presumptive Signs procedure Amenorrhea – absence of menses  Afterward, she should be Nausea and Vomiting placed on her left side. Increased breast sensitivity and breast changes  The patient MUST Increased pigmentation EMPTY THE BLADDER. Constipation  Vital signs are assessed Frequent urination every 15 minutes. Quickening  CALL THE PHYSICIAN Abdominal enlargement FOR THE FF: Chills, fever, leakage of fluid, decrease Probable Signs fetal movement or uterine contractions. Uterine enlargement Hegar’s Sign X-RAY  Done only 2 weeks Goodell’s Sign before EDC Chadwick’s Sign Ballottement ALPHA-FETOPROTEIN  Test done between 16 Braxton Hick’s contraction SCREENING and 18 weeks Positive Pregnancy Test gestation. Maternal serum  Normal Value: 10 Positive Signs screens for open mg/dl Fetal Heart Tone neural tube defects.  LOW: Chromosomal X-ray or Ultrasound of fetus defects Palpable fetal movements  HIGH: Neural tube defects.C. Maternal and Fetal Diagnostic Test LECITHIN -  Done through CHORIONIC VILLI  Performed between the SPHINGOMYELIN – AMNIOCENTESIS SAMPLING 8th – 11th weeks of (L/S RATIO)  Perform at 35-36 weeks gestation.  Position: Supine. Removal of a small  Laboratory results are Uses amniotic fluid to  Place folded towel on the piece of Chorionic villi obtained in 1 - 7 days ascertain fetal lung right buttocks. maturity  Needle insertion in a 20- Disadvantages: 22 gauge spinal needle, Risk of Abortion withdrawing amniotic Infection fluid. Embryo-fetal/placental  NORMAL L/S RATIO damage (lecithin/sphingomyelin) Spontaneous abortion : 2:1 = normal fetal lung Premature rupture of the maturity ratio membranesPOSSIBLE TOPICS ON MATERNAL AND CHILD HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE studentson the possible topics that might be part of the upcoming Dec 2012 PNLE
  • 2. WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESSPART 2: MATERNAL AND CHILD HEALTH NURSING LEOPOLDS  Palpate with warm hands. Constipation Due to Increased fluids and MANEUVER  Use palms, not fingertips. displacement roughage in the diet.  Woman should lie in of the stomach Regular elimination supine position with knees and intestines; time. flexed slightly. iron Increase exercise  Done with empty bladder. supplements Avoid enemas, harsh 1st: Presenting Part laxatives and mineral 2nd: Fetal Back oil. 3rd: Engagement Hemorrhoids Pressure of Warm sitz bathing 4th: Descent growing fetus, High fiber diet and Increase increase fluid. venous Sit on soft pillowTeTox Routine Immunization of Pregnant Women pressure Urinary Increase blood Sleep on the side at Vaccine Minimum Duration of Frequency supply to the night. Interval Protection kidney/ Limit fluid intake TeTox 1 As early as Pressure of during evening possible enlarged Bladder training during uterus in the pregnancy 3rd Tri TeTox 2 4 weeks after infant will be Backache From Back exercise (pelvic TeTox 1 protected by exaggerated rock) Minimum neonatal tetanus lumbo-sacral Wear low-heeled shoes. required 3 years protection curving during Avoid heavy lifting TeTox for for the mother pregnancy. pregnant Leg Cramps Increase Frequent rest with feet mother pressure of elevated TeTox 3 6 months infant will be gravid fetus, Regular exercise like after TeTox 2 protected by low calcium walking neonatal tetanus Increase milk intake 5 years protection Ankle Edema From venous Elevate legs at least for the mother stasis twice a day. TeTox 4 1 year after infant will be Sleep on left side TeTox 3 protected by Fatigue Due to Get regular exercise neonatal tetanus hormonal Sleep as much as 10 years changes needed. protection for the Avoid stimulants. mother Breast Increase Wear well fitted bra TeTox 5 1 year after all infant born to Tenderness estrogen and Warm compress TeTox 4 that mother will be progesterone protected level lifetime protection for the mother E. Formula Used In Providing Estimates In PregnancyD. Discomfort of Pregnancy To estimate the EDC Changes Reason Health Teachings Given the Use FormulaNausea and Increased HCG Dry crackers 30 min. Last Menstrual Nagele’s Rule First day of LMP –Vomiting before arising Period (LMP) 3 months + 7 days Small, frequent, low fat Date of Primi: meals Quickening Q + 4 months + 20 Avoid anti-emetics. daysHeartburn Increased Pats of butter before progesterone meals Multi: which decrease Avoid fried, fatty foods Q + 5 months + 4 gastric motility Sips of milk at frequent days causing intervals. esophageal Small, frequent meals reflux. taken slowly. Bends at the knees, not at the waistPOSSIBLE TOPICS ON MATERNAL AND CHILD HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE studentson the possible topics that might be part of the upcoming Dec 2012 PNLE
  • 3. WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESSPART 2: MATERNAL AND CHILD HEALTH NURSINGFundus Height at Various Week INTERPRETATION: Early Deceleration: Head Compression Late Deceleration: Utero-placental Insufficiency Variable Deceleration: Cord Compression H. Signs of Labor 1. Lightening – setting of fetal head into pelvic brim  occurs approximately 10-14 days before labor .  mother may experience: shooting leg pains from the increased pressure on the sciatic nerve, increased amounts of vaginal discharge and urinary frequency from pressure on the bladder 2. Increased in Level of Activity 3. Braxton Hicks Contractions 4. Ripening of the cervix 5. Weight Loss 6. Rupture BOW 7. Effacement and Dilation I. Length of LaborF. Pre-Natal Visit Stages of Labor Primigravida Multigravida Schedule of first visit is as soon as the woman missed her First Stage 12 and ½ hour 7hours and 20 menstrual period and pregnancy is suspected minutes Second Stage 80 minutes 30 minutesFirst 32 weeks : once a month32-36 weeks : twice a month Third Stage 10 minute 10 minutes36-40 weeks : every week TOTAL 14 hours 8 hoursG. Electronic Monitoring J. Nursing Care During LaborNon-Stress Test 1st Stage Latent  Accelerations in heart rate accompany normal fetal  Contractions are mild and short movement. Onset of true labor lasting 20-40 seconds  Observation of fetal heart rate related to fetal pain until  Cervix dilates from 0-3cm movement. complete cervical Monitor frequency, intensity, and FHT: Doppler: 8 weeks dilation and patterns of uterine contractions Fetoscope: 16 weeks / 4 months effacement Monitor fetal status during labor by Stethoscope: 20 weeks / 5months monitoring fetal heart rate  Teach mother to count 2-3 times daily, 30-60 minutes Assess bloody show (pink or blood each time, should feel 5-6 movements per counting streaked mucus), perineal bulging, time membrane statusPREPARATION: Monitor vital signs  Patient should eat snacks. Assess client’s ability to cope with  Position: Semi-Fowlers or left lateral positions contractions RESULTS: 1. Reactive (Normal): indicates a fetal fetus Provide emotional support  Greater than 15 beats per minute- occur with fetal movement in a 10 or 20 minute period. Active 2. Non-Reactive (Abnormal):  Dilatation increases from 4 – 7 cm  Contraction lasts 40-60 sec and occur  No fetal movement occurs every 3-5 minutes  The doctor will order an Oxytocin Test AFTER the patient has non-reactive test. Finds assessment techniques between contractionsContraction Stress Test (CST) Assists with frequent position  Response of the fetus to induced uterine contractions. change PREPARATION: Applies counter pressure to  Woman in semi-Fowler’s or side-lying position. sacrococcygeal area  Monitor for post-test labor onset. Encourages and praises  Indication: 28 weeks pregnancy high risk mother Keeps woman aware of progress  Contraindicated: Pre Term Labor Check bladder and encourages voidingPOSSIBLE TOPICS ON MATERNAL AND CHILD HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE studentson the possible topics that might be part of the upcoming Dec 2012 PNLE
  • 4. WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESSPART 2: MATERNAL AND CHILD HEALTH NURSING Transitional K. Micronutrient Supplementation  Contractions reached their peak of intensity occurring every 2-3 minutes Vitamin A Supplementation with duration of 60-90sec  Maximum dilatation 8-10cm Target Prep. Dose Duration  Complete cervical effacement Pregnant 100,000 1 cap Start from the 4th month Woman experiences intense Women IU 2x a of pregnancy until discomfort accompanied by nausea week delivery and vomiting Post 200,000 1 cap One dose only within 4 Woman may also experience a Partum IU weeks after delivery feeling of loss of control, anxiety, Women panic or irritability Iron Supplementation2nd Stage Prep client for delivery Immediate assessment of the Target Prep. Dose / Duration RemarksFrom complete newborn Pregnant Coated 1 tab/day for 6dilation and 6 Cardinal Movements of the Women Tab. months or 180 dayseffacement to Mechanism of labor contains during pregnancydelivery of the 1. Descent 60 mg period A dose offetus 2. Flexion elemental OR 800 mcg 3. Internal Rotation iron with 2 tab/day if prenatal folic acid is 4. Extension 400 mg consultation are still safe to 5. External Rotation folic acid done during the pregnant 6. Expulsion 2nd/3rd trimester woman3rd Stage Assess umbilical cord for 3 vessels Lactating Coated 1 tab / day for 3 (2 arteries, 1 vein) Women Tab. months or 90 daysFrom delivery of Assess placenta for intactness containsthe fetus to The fundus should be midline at or 60 mgdelivery of the 2 cm. below the umbilicus elementalplacenta Don’t hurry the expulsion of the iron with placenta, just watch for the signs of 400 mg placental separation: folic acid Lengthening of the cord Sudden gush of blood Change of shape of the uterus L. Pregnancy Complications Palpate the uterus to determine degree of contraction. If relaxed, ABORTION massage gently and apply ice cap  Threatened, the continuation of the pregnancy is in Inspect for lacerations doubt The fundus should descend  Inevitable, loss that can be prevented approximately 1-2 cm every 24  Complete, products of conception are totally expelled hours  Incomplete, some fragments are retained inside the4th Stage Promote parent-infant bonding uterine cavity Assess maternal vital signs, fundal  Missed, retention of the products of conception afterThe period of height, lochia and bladder fetal deathimmediate distention  Habitual, 3 spontaneous abortions occurringrecovery and successivelyobservation after Degrees of Perineal Lacerations:delivery of the ECTOPIC PREGNANCYplacenta 1. First Degree – skin and superficial to  A pregnancy that occurs in another than uterine muscle site, with implantation usually occurring in fallopian 2. Second Degree – muscles of the tubes perineum  Knife-like abdominal pain 3. Third Degree – continues to anal  Profound shock if rupture occurs sphincter Symptoms of Shock: 4. Fourth Degree – involves the anterior decreased BP anal wall Increased RR, Fast but thready pulse  Surgery: SalpingostomyPOSSIBLE TOPICS ON MATERNAL AND CHILD HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE studentson the possible topics that might be part of the upcoming Dec 2012 PNLE
  • 5. WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESSPART 2: MATERNAL AND CHILD HEALTH NURSINGINCOMPETENT CERVIX  ECLAMPSIA: to prevent aspiration, turn the  Painless premature dilatation of the cervix (usually in woman on her side to allow secretions to drain the 16th to 20th week) from her mouth.  #1 Sign: Rupture of membranes and discharge of  SEVERE PRECLAMPSIA: Lateral recumbent amniotic fluid position  Best Position: Side lying position  DOC: Magnesium Sulfate  Pre-op: Encourage patient to maintain bed rest  Magnesium Sulfate Toxicity:  Post-op: Check for excessive vaginal discharge and Decrease urine output severe pain. Decrease RR  Bed rest in trendelenburg position Absence of reflexes  Administer tocolytic medications as ordered  Antidote: CALCIUM GLUCONATE Eg; Ritodrine Hydrochloride (Yutopar)  Surgery: Cervical Cerclage  Shirodkar-Barter Technique ( internal PLACENTA PREVIA os) permanent suture: subsequent  Improperly implanted placenta in the lower uterine delivery by C/S. segment near or over the internal cervical os  Mc Donald Procedure ( external os)-  Total: the internal os is entirely covered by the suture removed at term with vaginal placenta when cervix is fully dilated delivery  Marginal: only an edge of the placenta extends to the internal osCARDIAC DISEASE  Low-lying placenta: implanted in the lower uterine  Class I: no limitation of activities. No symptoms of segment but does not reach the os cardiac insufficiency.  Painless Bleeding  Class II: slight limitation of activity, Asymptomatic  #1 Assessment - Monitor maternal vital signs, at rest. Ordinary activities causes fatigue, FHR, and fetal activity palpitations and dyspnea  Best Position: Left Lateral  Class II: marked limitation of activities, comfortable at rest, less than ordinary activities causes discomforts ABRUPTIO PLACENTA  Class IV: unable to perform any physical activity  Premature separation of the placenta from the without discomfort. May have the symptoms during uterine wall after the 20th week of gestation and rest. before the fetus is delivered.  Abruptio placentae is associated with conditions characterized by poor uteroplacental circulation,GESTATIONAL DIABETES such as hypertension, smoking and alcohol or cocaine  Diabetes during pregnancy. abuse.  3-P’s: Polyuria, Polydipsia and Polyphagia  Painful vaginal bleeding  Because insulin does not pass into the breast  Board-like rigidity of abdomen milk, breastfeeding is not contraindicated for the  The goal of management in abruption placentae is to mother with diabetes control the hemorrhage and deliver the fetus as soon  Maternal Complications: PIH, Placental disorders, as possible stillbirth, macrosomia, neural tube defects.  Screen clients between the 24th and 28th weeks of M. Post Partum pregnancy  If a pregnant diabetic is in labor, her blood glucose LOCHIAL CHANGES should be monitored hourly.  Lochia Rubra  Treatment: Insulin therapy (don’t use Oral • Dark red discharge occurring in the first 2-3 days. hypoglycemics, they are Teratogenic) • Characteristic human odor.  Lochia SerosaPREGNANCY INDUCED HYPERTENTION (PIH) • Pinkish to brownish discharge occurring 3-10 days  Blood pressure over 140/90, or increase of 30 mm after delivery. systolic, 15 mm diastolic over pre-pregnancy level • Has a strong odor.  Pre Eclampsia: HPN, Protenuria , Edema (face&hand)  Lochia Alba  Eclampsia: HPN, Protenuria, Edema plus Fever and • Almost colorless to creamy yellowish discharge Epigastric pain. occurring from 10 days to 3 weeks after delivery.  During pregnancy, blurred vision may be a danger • Has no odor. sign of preeclampsia or eclampsia.  Monitor VS, I&O and breath soundPOSSIBLE TOPICS ON MATERNAL AND CHILD HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE studentson the possible topics that might be part of the upcoming Dec 2012 PNLE
  • 6. WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESSPART 2: MATERNAL AND CHILD HEALTH NURSINGUTERINE INVOLUTION intake Process of involution takes 4-6 weeks to complete. DIGESTIVE IMMATURE CARDIAC SPHINCTER Weight decreases from 2 lbs to 2 oz. SYSTEM – may allow reflux of food, burped, Fundus steadily descends into true pelvis; Fundal height REGURGITATE-placed NB right decreases about 1 fingerbreadth (1 cm)/day; by 10-14 side after feeding days postpartum, cannot be palpated abdominally. FIRST STOOL is MECONIUM - Black, tarry residue from lower intestine - Usually passed within 12-24 hours after birth TRANSITIONAL STOOLS thin, brownish green in color After 3 days MILK STOOLS: a. MILK STOOLS for BF infant – loose and golden yellow b. MILK STOOLS for FORMULATED FED- formed and pale yellow HEPATIC Pathologic Jaundice, yellowish discoloration immediately after birth Physiologic Jaundice, yellowish discoloration 2-3 days after birth (normal)NOTE: Deviation of the fundus to the right or left and location TEMPERATURE Axillary temperature: 96.8 to 99Fof the fundus above the umbilical are signs that the bladder is Newborn can’t shiver as an adultdistended does to release heat Cold stress increases o2N. Care of the Newborn consumption – may lead to metabolic acidosis and respiratory  Suction the mouth first before the nose distress  Delay initial bath until temp. has stabilized for at IMMUNOLOGIC NB develops own antibodies least 6 hours. during 1st 3 months but at risk for  APGAR scoring is taken twice: initially @ 1 minute, infection during the first 6 weeks and then @ 5 minutes after birth  Give prophylactic eye treatment (credes ointment) against gonorrheal conjunctivitis or ophthalmia P. Freud’s Theory neonatorum within the first hour after delivery.  Prevent hemorrhage , give 0.5mg (preterm) to 1 Freud’s Psychoanalytic Theory mg (full term) Vit. K or Aquamephyton is injected Psychosexual Development IM in the NB’s vastus lateralis (lateral anterior Infants Oral Stage thigh)muscle (birth to 1  Child explores the world by using  The cord is clamped and cut approximately within year) mouth, especially the tongue 30 seconds after birth when cord pulsation stop  Baby finds pleasure in the mouth  The cord stump usually dries and fall within 7 to Toddler Anal Stage 10 days (1-3 y/o)  Child learns to control urination and defecation (18 months)O. Newborn Assessment  Toilet training Preschooler Phallic StageCIRCULATORY DUCTUS ARTERIOSUS constrict (3-6y/o)  The genitals are the pleasure of theSTATUS with establishment of respiratory child function, remains open cause PDA  Oedipus and Electra Complex (patent ductus arteriosus)  Masturbation is common during this FORAMEN OVALE closes phase and may also show functionally as respirations exhibitionism established, remains open cause School-Age Latent Stage / Latency Period ASD (atrial septal defect) (6-12 y/o)  Child’s personality developmentRESPIRATORY RR = 30-80 breaths /minutes with appears to be nonactive or dormantSTATUS short periods of apnea (< 15 Adolescent Genital Stage seconds) (13-20 y/o)  Adolescent develops sexual maturityRENAL SYSTEM Later pattern is 6-10 voidings/ and learns to establish satisfactory day – indicative of sufficient fluid relationships w/ the opposite sexPOSSIBLE TOPICS ON MATERNAL AND CHILD HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE studentson the possible topics that might be part of the upcoming Dec 2012 PNLE
  • 7. WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESSPART 2: MATERNAL AND CHILD HEALTH NURSINGQ. Erikson’s Theory R Physical Growth and Development Erikson’s Theory of Psychosocial Development Mo. Gross Fine Motor Infants Trust vs. Mistrust Yr. Motor Development Development(birth to 1  Fear: strangers, anxiety, loud noises,  Largely reflex  The eyes is fixated on year) falls, sudden movements in the 0-1 the person environment  Keeps hands fisted  Play: Solitary  Holds head up  Development of  Learning confidence or learning to when prone social smile love, 2  Responds to familiar Toddler Autonmy vs. Shame voice (1-3 y/o)  Psychosocial Theme: “hold on or let  Holds head & chest  The baby knows how go” up when prone to cry  Play: Parallel 3  Laughs aloud  Child learns to be independent and  Babbles and “coos” make decisions for self  Grasp  Can raise head and  Favorite word: “I”, “no”  Stepping chestPreschooler Initiative vs. Guilt  Tonic neck  Reach out to object (3-6y/o)  Ability to try new things 4  Reflexes are fading  Bogus playmates/imaginary  Turns front to back  Roll over  Fears: dark, being left alone, large 5  Has head lag when  Hold blocks at each animals, ghosts, body mutilation, pulled upright hand pain & objectsSchool-Age Industry vs. Inferiority  Turns both ways  Doubles birth weight(6-12 y/o)  Makes things w/ others  Moro reflex fading  Eruption of 1st tooth  Strives to achieve success  Sits w/ minimal  Child learns how to do things well 6 supportAdolescent Identity vs. Role Confusion  Uses palmar grasp(13-20 y/o)  Determines own sense of self  Reaches out in  “dada”, “mama”  Development of who, what & where anticipation of  Sleeps on prone they are going being picked up position  Adjusting to a new body and seeking 7  Sits unsteadily  Uses fingers to hold emancipation from parents, choosing objects a vocation & determining a value  Transfers objects system hand to hand Young Intimacy vs. Isolation Adult  Person makes commitments to one  Sits securely w/o  Sits alone steadily for another support an indefinite period  Isolation and self absorption if 8  Recognizes strangers unsuccessful  Peek-a-boo (to test  Independent from parents, possible memory) marriage / partnership  Major goals to accomplish in career  Creeps or crawls  Can hold own bottle and family  Starts to crawl Middle Generativity vs. Stagnation 9  Understands simple Adult  Physical Changes: graying hair, gestures wrinkling skin, pain & muscle aches, menopausal period  Pulls self to  From crawling to  Mature adult is concerned w/ standing standing establishing & guiding the new 10  Responds when generation or else feels personal called by his/her impoverishment name  Become “Pillars of the Community”  From crawling to  Walks withOlder Adult Integrity vs. Despair 11 standing assistance  Achieves sense of acceptance of own life  Stands alone  Triples birth weight  Adapts to triumphs & disappointment 12  Some infants take  Can say 2 syllable w/ a certain ego integrity 1st step words  Can walk w/ helpPOSSIBLE TOPICS ON MATERNAL AND CHILD HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE studentson the possible topics that might be part of the upcoming Dec 2012 PNLE