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Mcnc ppt  week 2

Mcnc ppt week 2






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    Mcnc ppt  week 2 Mcnc ppt week 2 Presentation Transcript

    • 2
      Conception & Fetal Development?
      Physical &
      Changes of
      Antepartal Nursing Assessment?
      Reproductive Anatomy &
    • Maternal & Child Nursing Care
      Reproductive Anatomy andPhysiology
    • Learning Objectives
      Identify the structures and functions of the female and male reproductive systems.
      Summarize the actions of the hormones that affect reproductive functioning.
      Identify the two phases of the ovarian cycle and the changes that occur in each phase.
    • Describe the phases of the menstrual cycle, their dominant hormones, and the changes that occur in each phase.
      Discuss the significance of specific female reproductive structures during childbirth.
      Identify the functions of specific male reproductive structures for reproduction.
    • FIGURE 3–1 Sexual differentiation. A, At 7 weeks’ gestation, male and female genitalia are identical(undifferentiated). B and C, By 12 weeks’ gestation, noticeable differentiation begins to occur.D and E, Differentiation continues until birth but is almost complete at term.
    • FIGURE 3–2 Physiologic changes leading to onset of puberty. A, In females, and B, in males. Solid lines illustrate stimulation of hormone production, and broken lines illustrate inhibition. Through a neurotransmitter the central nervous system stimulates the hypothalamus, which in turn produces a gonadotropin-releasing factor that causes the anterior pituitary to produce gonadotropins (FSH or LH). These hormones stimulate specific structures in the gonads to secrete steroid hormones (estrogen, progesterone, or testosterone). The rise in pituitary hormone increases hypothalamus activity. Elevated steroid hormone levels stimulate the central nervous system and pituitary gland to inhibit hormone production.
    • Female Reproductive System
      External genitalia/vulva
      Mons pubis
      Labia majora
      Labia minora
      Urethral meatus and opening of the paraurethral glands
      Vaginal vestibule
      Breasts: Accessories of the reproductive system
    • Female external genitals, longitudinal view.
    • FIGURE 3–14 Anatomy of the breast: sagittal view of left breast.
    • Female Reproductive System
      Internal genitalia
      Ovaries and fallopian tubes
      Cervix and uterus
    • FIGURE 3–4 Female internal reproductive organs
    • FIGURE 3–5 Structures of the uterus.
    • FIGURE 3–8 Uterine ligaments.
    • FIGURE 3–9 Fallopian tubes and ovaries.
    • Male Reproductive System
      Epididymis, vas deferens and ejaculatory duct
      Accessory glands
    • Male reproductive system, sagittal view.
    • Schematic representation of a mature spermatozoon
    • Hormones
      Female Hormones
      Male Hormones
      Testosterone is the most important sex hormone
    • Estrogen
      Controls development of female secondary sex characteristics
      Assists in the maturation of the ovarian follicles
      Causes endometrial mucosa to proliferate following menstruation
      Causes uterus to increase in size and weight
    • Female reproductive cycle: interrelationships of hormones with the four phases of the uterine cycle and the two phases of the ovarian cycle in an ideal 28-day cycle
    • Estrogen
      Increases myometrial contractility in both the uterus and fallopian tubes
      Increases uterine sensitivity to oxytocin
      Inhibits FSH production
      Stimulates LH production
    • Progesterone
      Decreases uterine motility and contractility
      Facilitates vaginal epithelium proliferation
      Secretion of thick viscous cervical mucus
      Increases breast glandular tissue in preparation for breast feeding
    • Prostaglandin
      Prostaglandin: Increases during follicular maturation
      Causes extrusion of the ovum
    • FIGURE 3–16 Various stages of development of the ovarian follicles.
    • Follicular Phase
      Hypothalamus secretes gonadotropin-releasing hormone (GnRH)
      GnRH stimulates the anterior pituitary gland to secrete the gonadotropic hormones, follicle-stimulating hormone (FSH), and luteinizing hormone (LH)
      FSH is primarily responsible for the maturation of the ovarian follicle
    • Follicular Phase (cont’d)
      As the follicle matures, it secretes increasing amounts of estrogen
      Final maturation facilitated by LH
      The follicular phase ends with ovulation
    • Luteal Phase
      Release of ovum
      LH: Corpus luteum develops from ruptured follicle
      Secretion of progesterone increases
      Fertilized ovum able to implant into endometrium
      Secretion of human chorionic gonadotropin (hCG)
      Absence of fertilization
      Corpus luteum degenerates
      Decrease in estrogen and progesterone
      Increase in LH and FSH
    • Menstrual Phase
      Shedding of the endometrial lining
      Low estrogen levels
    • Proliferative Phase
      Enlargement of the endometrial glands
      Changes in cervical mucus
      Increasing estrogen levels
    • Secretory Phase
      Follows ovulation
      Influenced primarily by progesterone
      Increase in vascularity of the uterus
      Increase in myometrial glandular secretions
    • Ischemic Phase
      If fertilization does not occur, the ischemic phase begins
      The corpus luteum begins to degenerate
      Both estrogen and progesterone levels fall
      Escape of blood into the stromal cells of the endometrium
    • A
      FIGURE 3–12 Female pelvis. A, The false pelvis is a shallow cavity above the inlet; the true pelvis is adeeper portion of the cavity below the inlet.
    • B
      FIGURE 3–12 (continued) Female pelvis. A, The false pelvis is a shallow cavity above the inlet; the true pelvis is adeeper portion of the cavity below the inlet. B, The true pelvis consists of the inlet, cavity(midpelvis), and outlet.
    • Division of the Pelvis
      False pelvis
      Part above the pelvic brim
      Serves to support the weight of the enlarged pregnant uterus
      Directs the presenting fetal part into the true pelvis
      Inlet: upper border of pelvis
      Pelvic cavity: Curved canal with a longer posterior than anterior wall
      Outlet: Pelvic outlet is at the lower border of the true pelvis
    • FIGURE 3–13 Pelvic planes: coronal section and diameters of the bony pelvis.
    • Basic Pelvic Types
    • Male Reproductive Structures
      Testes; seminal fluid
    • Male Reproductive Structures
      Vas deferens
    • Functions of Male Reproductive Structures
      Penis: Deposits sperm in the vagina for fertilization of the ovum
      Scrotum: Protects testes and sperm by maintaining a temperature lower than the body
      Serve as a site for spermatogenesis
      Produce testosterone
      Seminal fluid: Transports viable and mobile sperm to female reproductive tract
    • Functions of Male Reproductive Structures
      Epididymis: Reservoir for maturing spermatozoa
      Vas deferens: Rapidly squeeze sperm from their storage sites into urethra
      Urethra: Passageway for both urine and semen
    • Assignment
      Complete the activities: “Female Reproductive System”and “Male Reproductive System” on the accompanying Student CD-ROM.
      View the animations on the CD-ROM on the female and male pelvis.
    • Conception and Fetal Development
    • Learning Objectives
      Compare the difference between meiotic cellular division and mitotic cellular division.
      Compare the processes by which ova and sperm are produced.
      Describe the components of the process of fertilization.
    • Describe in order of increasing complexity the structures that form during the cellular multiplication anddifferentiation stages of intrauterine development.Describe the development, structure, and functions of the placenta and umbilical cord during intrauterine life
      Identify the differing processes by which fraternal (dizygotic) and identical (monozygotic) twins are formed
      Summarize the significant changes in growth and development of the fetus in utero at 4, 6, 12, 16, 20, 24, 28, 36, and 40 weeks’ gestation.
    • Mitosis
      Process of cellular division
      Results in daughter cells that are exact copies of the original cell
      Identical to parent cell and to each other
      Contain a full set of chromosomes or genetic material
      Refered to as diploid cells
      Somatic cells continue to reproduce and replace each other
    • Mitosis
      The cell undergoes several changes ending in cell division
      At the last phase of cell division, a furrow develops in the cell cytoplasm
      The parent cell divides into two daughter cells
      Each daughter cell has its own nucleus
      They are identical to the parent cell
      They have the same diploid number of chromosomes (46) and same genetic makeup as the cell from which they came
    • Meiosis
      Type of cell division that produces reproductive cells called gametes (sperm and ova) - each cell contains half genetic material of parent cell (haploid)
    • Meiosis (cont’d)
      Meiosis consists of two successive cell divisions
      First division: Chromosomes replicate
      Second division: Chromatids of each chromosome separate and move to opposite poles of each of the daughter cells
      Cellular division results in formation of four cells
      Each cell contains haploid number of chromosomes
      Daughter cells contain only half the DNA of normal somatic cell
    • Comparison of Meiosis and Mitosis
    • FIGURE 7–1 Gametogenesis involves meiosis within the ovary and testis. A, During meiosis, eachoogonium produces a single haploid ovum once some cytoplasm moves into the polar bodies.B, Each spermatogonium produces four haploid spermatozoa.
    • Oogenesis
      Process that produces the female gamete, called an ovum (egg), that begins to develop early in the fetal life of the female
      Ovaries begin to develop early in the fetal life of the female
      All ova that female will produce in her lifetime are present at birth - ovary gives rise to oogonial cells, which develop into oocytes
      During puberty: Mature primary oocyte continues through first meiotic division in ovary
      Haploid cells released at ovulalion
    • Oogenesis
      The first meiotic division
      Two cells of unequal size produced with same number of chromosomes
      One cell is secondary oocyte, other is minute polar body
      Secondary oocyte and polar body each contain 22 double-structured autosomal chromosomes and one double-structured sex chromosome (X)
      During puberty: Mature primary oocyte continues through first meiotic division in ovary
    • Spermatogenesis
      Production of the male gamete, or sperm, during puberty
      The spermatogonium (primordial germ cell)
      Begins with complete set of genetic material - diploid number of chromosomes
      Cell replicates before it enters first meiotic division
      Cell is now primary spermatocyte
      During second meiotic division, divide to form four spemiatids, each with haploid number of chromosomes
    • Spermatogenesis (cont’d)
      During the first meiotic division
      Spermatogonium forms two cells called secondary spermatocytes
      Each contains 22 double-structured autosomal chromosomes and either double-structured X sex chromosome or double-structured Y sex chromosome
    • Preparation for Fertilization
      Preparation is the first component of fertilization
      Ovum released into fallopian tube - viable for 24 hours
      Sperm deposited into vagina - viable for 48 to 72 hours (highly fertile for 24 hours)
      Sperm must undergo capacitation and acrosomal reaction
      Sperm penetration causes a chemical reaction that blocks more sperm penetration
    • Moment of Fertilization
      Sperm penetration causes chemical reaction that blocks more sperm penetration
      Sperm enters ovum, chemical signal prompts secondary oocyte to complete second meiotic division
      True moment of fertilization occurs as nuclei unite
      Chromosomes pair up to produce diploid zygote
      Each nucleus contains haploid number of chromosomes (23)
    • Moment of Fertilization (cont’d)
      Union restores diploid number (46)
      Zygote contains new combination of genetic material
      Sex of zygote determined at moment of fertilization
      Two chromosomes of twenty-third pair (sex chromosomes) - either XX or XY - determine sex of individual
      Females have two X chromosomes, males have an X and a Y chromosome
    • A
      FIGURE 7–2 Sperm penetration of an ovum. A, The sequential steps of oocyte penetration by a spermare depicted moving from top to bottom. B, Scanning electron micrograph of a human sperm surrounding a human ovum (750). The smaller spherical cells are granulosa cells of the corona radiata. Scanning electron micrograph used with permission from Nisson, L. (1990). A child is born. New York: Dell publishing.
    • B
      FIGURE 7–2(continued) Sperm penetration of an ovum. A, The sequential steps of oocyte penetration by a sperm are depicted moving from top to bottom. B, Scanning electron micrograph of a human spermsurrounding a human ovum (750). The smaller spherical cells are granulosa cells of the corona radiata. Scanning electron micrograph used with permission from Nisson, L. (1990). A child is born. New York: Dell publishing.(Photo Lennart Nilsson/Albert Bönniers Folag AB)
    • FIGURE 7–3 During ovulation the ovum leaves the ovary and enters the fallopian tube. Fertilizationgenerally occurs in the outer third of the fallopian tube. Subsequent changes in the fertilizedovum from conception to implantation are depicted.
    • Cell Multiplication
      Rapid mitotic division - cleavage
      Blastomeres grow to morula (solid ball of 12 to 16 cells) - solid ball of 12 to 16 cells
      Morula divides into solid mass (blastocyst); surrounded by outer layer of cells (trophoblast)
      Implantation; occurs in 7 to 10 days
    • Cell Differentiation
      10 to 14 days (ectoderm, mesoderm, and endoderm) from which all tissues, organs, and organ systems develop
      Blastocyst differentiates into three primary germ layers (ectoderm, mesoderm, and endoderm)
      All tissues, organs, and organ systems develop from these primary germ cell layers
      Embryonic membranes form at implantation
      The chorion and the amnion
    • Derivation of Body Structures from Primary Cell Layers
    • Cell Differentiation
      Amniotic Fluid: Created when amnion and chorion grow and connect andform amniotic sac to produce fluid
      Yolk sac
      DeveIops as part of the blastocyst
      Produces primitive red blood cells
      Soon incorporated into the umbilical cord
    • FIGURE 7–4 Formation of primary germ layers. A, Implantation of a 7 1/2-day blastocyst in which thecells of the embryonic disc are separated from the amnion by a fluid-filled space. The erosion of the endometrium by the syncytiotrophoblast is ongoing. B, Implantation is completed by day 9, and extraembryonic mesoderm is beginning to from a discrete layer beneath the cytotrophoblast. C, By day 16 the embryo shows all three germ layers, a yolk sac, and an allantois (an out pouching of the yolk sac that forms the structural basis of the body stalk, or umbilical cord). The cytotrophoblast and associated mesoderm have become the chorion, and chorionic villi are developing.
    • Cell Differentiation
      Endoderm - differentiation of endoderm results in formation of epithelium lining respiratory and digestive tracts
    • FIGURE 7–5 Endoderm differentiates to form the epithelial lining of the digestive and respiratory tractsand associated glands.
    • FIGURE 7–6 Early development of primary embryonic membranes. At 4 1/2 weeks, the decidua capsularis (placental portion enclosing the embryo on the uterine surface) and decidua basalis (placental portion encompassing the elaborate chorionic villi and maternal endometrium) are well formed. The chorionic villi lie in blood-filled intervillous spaces within the endometrium. The amnion and yolk sac are well developed.
    • Umbilical Cord
      Develops from amnion
      Body stalk attaches embryo to yolk sac, fuses with embryonic portion of placenta
      Provides pathway from chorionic villi to embryo
      Contains two arteries and one vein; surrounded by Wharton’s jelly to protect vessels
      Wharton’s jelly: Specialized connective tissue
      Protects blood vessels
      Function of umbilical cord: Provides circulatory pathway to embryo
    • Placenta
      Placental development
      Begins at third week of embryonic development
      Develops at site where embryo attaches to uterine wall
      Function: Metabolic and nutrient exchange between embryonic and maternal circulations
      Placenta has two parts
    • Placenta
      Maternal portion
      Consists of deciduas basalis and its circulation
      Surface appears red and flesh-like
      Fetal portion
      Consists of the chorionic villi and their circulation
      The fetal surface of the placenta is covered by the amnion
      Appears shiny and gray
    • FIGURE 7–8 Maternal side of placenta (Dirty Duncan).
    • FIGURE 7–9 Fetal side of placenta (Shiny Shultz).
    • FIGURE 7–10 Vascular arrangement of the placenta. Arrows indicate the direction of blood flow. Maternal blood flows through the uterine arteries to the intervillous spaces of the placenta and returnsthrough the uterine veins to maternal circulation. Fetal blood flows through the umbilical arteries into the villous capillaries of the placenta and returns through the umbilical vein to the fetal circulation.
    • FIGURE 7–11 Fetal circulation. Blood leaves the placenta and enters the fetus through the umbilicalvein. After circulating through the fetus, the blood returns to the placenta through the umbilical arteries. The ductus venosus, the foramen ovale, and the ductus arteriosus allow the blood to bypass the fetal liver and lungs.
    • Figure 7–7 A, Formation of fraternal twins. (Note separate placentas.) B, Formation of identical twins.
    • Figure 7–7 (continued) A, Formation of fraternal twins. (Note separate placentas.) B, Formation of identical twins.
    • Identical Twins
      Develop from single fertilized ovum
      Of same sex and have same genotype
      Identical twins usually have common placenta; monozygosity is not affected by environment, race, physical characteristics, or fertility
      Both fetus are same sex with same characteristics
      Single placenta
    • Identical Twins
      Number of amnions and chorions present - depends on timing of division
      Division within 3 days of fertilization; two embryos, two amnions, and two chorions will develop
      Division about 5 days after fertilization
      Two embryos develop with separate amniotic sacs
      Sacs will eventually be covered by a common chorion
      Monochorionic-diamniotic placenta
    • Identical Twins (cont’d)
      If amnion already developed, division approximately 7 to 13 days after fertilization
      Two embryos with common amniotic sac and common chorion
      Monochorionic-monoamniotic placenta
      Occurs about 1% of the time
    • Fraternal Twins
      Also referred to as dizygotic
      Arise from two separate ova fertilized by two separate spermatozoa
      Two placentas, two chorions, and two amnions
      Sometimes placentas fuse and appear to be one
      Fraternal twins
      No more similar to each other than singly bom siblings
      May be of same or different sex
    • FIGURE 7–12 The actual size of a human conceptus from fertilization to the early fetal stage. The embryonic stage begins in the third week after fertilization; the fetal stage begins in the ninthweek.
    • Fetus Growth and Development
      4 weeks: 4–6 mm, brain formed from anterior neural tube, limb buds seen, heart beats, GI system begins
      6 weeks: 12 mm, primitive skeletal shape, chambers in heart, respiratory system begins, ear formation begins
    • Fetus Growth and Development
      12 weeks: 8 cm, ossification of skeleton begins, liver produces red cells, palate complete in mouth, skin pink, thyroid hormone present, insulin present in pancreas
      16 weeks: 13.5 cm, teeth begin to form, meconium begins to collect in intestines, kidneys assume shape, hair present on scalp
    • FIGURE 7–13 The embryo at 5 weeks. The embryo has a marked C-shaped body and a rudimentary tail. Use with permission from Petit/Nestle/Science Source/Photo Researchers, Inc.
    • FIGURE 7–14 The embryo at 7 weeks. The head is rounded and nearly erect. The eyes have shifted forward and closer together, and the eyelids begin to form. Use with permission from Petit/Nestle/Science Source/Photo Researchers, Inc.
    • FIGURE 7–15 The fetus at 9 weeks. Every organ system and external structure is present. Use with permission from Nilsson, L. (1990). A child is born. New York: Dell Publishing.(Photo Lennart Nilsson/Albert Bönniers Folag AB)
    • FIGURE 7–16 The fetus at 14 weeks. During this period of rapid growth, the skin is so transparent that blood vessels are visible beneath it. More muscle tissue and body skeleton have developed,and they hold the fetus more erect. Use with permission from Nilsson, L. (1990). A child is born. New York: Dell Publishing.(Photo Lennart Nilsson/Albert Bönniers Folag AB)
    • FIGURE 7–17 The fetus at 20 weeks weighs 435 to 465 g and measures about 19 cm. Subcutaneousdeposits of brown fat make the skin a little less transparent. “Woolly” hair covers the head,and nails have developed on the fingers and toes. Use with permission from Nilsson, L. (1990). A child is born. New York: Dell Publishing.(Photo Lennart Nilsson/Albert Bönniers Folag AB)
    • Fetus Growth and Development
      20 weeks: 19 cm, myelination of spinal cord begins, suck and swallow begins, lanugo covers body, vernix begins to protect the body
      24 weeks: 23 cm, respiration and surfactant production begins, brain appears mature
      28 weeks: 27 cm, nervous system begins regulation of some functions, adipose tissue accumulates; nails, eyebrows, and eyelids are present; eyes are open
      36 weeks: 35 cm, earlobes soft with little cartilage, few sole creases
    • Fetus Growth and Development
      40 weeks : 40 cm, adequate surfactant, vernix in skin folds and lanugo on shoulders, earlobes firm, sex apparent
      Weight about 3,000 to 3,600 g (6 lb., 10 oz. to 7 lb., 15 oz.)
      Varies in different ethnic groups
      Skin has a smooth, polished look
      Hair on head is coarse and about 1 inch long
      Body and extremities are plump
    • Fetal Development: What Parents Want to Know
    • Fetal Development: What Parents Want to Know (cont’d)
    • Assignment
      Access the CD-ROM to view the cell division animation.
      Review the following animations:oogenesis, spermatogenesis, oogenesis and spermato-genesis compared, matching oogenesis and spermatogenesis.
      View and review all animations.
    • Physical and Psychologic Changes of Pregnancy
    • Learning Objectives
      • Identify the anatomic and physiologic changes that occur during pregnancy.
      • Relate these anatomic and physiologic changes to the signs and symptoms that develop in the woman.
      • Compare subjective (presumptive), objective (probable), and diagnostic (positive) changes of pregnancy.
      • Contrast the various types of pregnancy tests.
      • Discuss the emotional and psychological changes that commonly occur in a woman, her partner, and her familyduring pregnancy.
      • Summarize cultural factors that may influence a family’s response to pregnancy.
    • Anatomic and Physiologic Changes
      Uterus: Increased amounts of estrogen and growing fetus
      Enlargement in size
      Increase in weight, strength, elasticity, and vascularity
      Cervix: Increase estrogen levels
      Formation of mucous plug
      Mucous plug prevents organisms entering uterus
    • Anatomic and Physiologic Changes
      • Vagina: Increased estrogen levels
      • Increased thickness of mucosa
      • Increased vaginal secretions to prevent bacterial infections
      • Connective tissue relaxes
      • Breasts: Increased estrogen and progesterone levels
      • Increase in size and number of mammary glands
      • Nipples more erectile and areolas darken
      • Colostrum produced during third trimester
    • Anatomic and Physiologic Changes
      Respiratory system: Increasing levels of progesterone causes:
      Increased volume of air
      Decreased airway resistance
      Increased anteroposterior diameter
      Thoracic breathing occurs as uterus enlarges
    • Anatomic and Physiologic Changes
      Cardiovascular system: Increased levels of estrogen and progesterone
      Cardiac output and blood volume increases
      Increased size of uterus interferes with blood return from lower extremities
      Increased level of red cells to increase oxygen delivery to cells
      Clotting factors increase
    • Anatomic and Physiologic Changes
      GI system: Action of increasing levels of progesterone
      Delayed gastric emptying
      Decreased peristalsis
      GU system: Increased blood volume
      Glomerular filtration rate increases
      Renal tubular reabsorption increases
    • Anatomic and Physiologic Changes
      Skin and Hair: Increased skin pigmentation caused by increased estrogen and progesterone
      Musculoskeletal: Relaxation of joints caused by increased estrogen and progesterone
      Metabolism: Increased during pregnancy
      Demands of the growing fetus and its support system
      Weight Gain: Recommended 25 to 35 lb
      Overweight, recommended gain is 15 to 25lb.
      Underweight: Gain weight needed to reach ideal weight plus 25 to 35 lb
    • Anatomic and Physiologic Changes
      Endocrine System
    • Signs and Symptoms
      Uterus: Enlargement of abdomen
      Increased strength and elasticity: Allows uterus to contract
      Fetus expelled during labor
      Cervix: Mucous plug expelled as labor begins
      Increased vascularity may cause bleeding after vaginal exams
      Vagina: Acid pH increases chance of vaginal yeast infections
      Breasts: Increase in size causes soreness
      Colostrum may be present during the third trimester
    • Signs and Symptoms
      Respiratory system
      Increased size of uterus may cause shortness of breath
      Increased vascularity may cause nasal stuffiness and nosebleeds
      Cardiovascular system: Decreased blood return from lower extremities
      Varicose veins
    • Signs and Symptoms (cont’d)
      Pressure on vena cava by the enlarged uterus
      Decreased blood pressure
      Skin and Hair: Increased skin pigmentation
      Causes linea nigra and chloasma
    • Signs and Symptoms (cont’d)
      GI system: Increased levels of estrogen cause:
      Nausea and vomiting
      Slow peristalsis and motility
      GU system: Increased urination caused by:
      Increasing size of uterus
      Pressure on bladder
      Increased blood volume and glomerular filtration
    • Signs and Symptoms (cont’d)
      Musculoskeletal: Action of estrogen and progesterone
      Relaxation of joints: Lordosis of lumbosacral spine
    • FIGURE 9–5 Approximate height of the fundus at various weeks of pregnancy.
    • FIGURE 9–2 Linea nigra.
    • FIGURE 9–1 Vena caval syndrome. The gravid uterus compresses the vena cava when the woman issupine. This reduces the blood flow returning to the heart and may cause maternal hypotension.
    • FIGURE 9–3 Postural changes during pregnancy. Note the increasing lordosis of the lumbosacral spine and the increasing curvature of the thoracic area.
    • Changes of Pregnancy
      Subjective (presumptive) changes
      Nausea and vomiting
      Urinary frequency
      Breast changes
    • Differential Diagnosis of Pregnancy - Subjective Changes
    • Differential Diagnosis of Pregnancy - Subjective Changes
    • Changes of Pregnancy
      Objective (probable) changes
      Goodell’s and Chadwick’s sign
      Hegar’s and McDonald’s sign
      Enlargement of the abdomen
      Braxton Hicks contractions
      Uterine soufflé
      Skin pigmentation changes
      Pregnancy tests
    • FIGURE 9–4 Hegar’s sign, a softening of the isthmus of the uterus, can be determined by the examinerduring a vaginal examination.
    • Differential Diagnosis of Pregnancy - Objective Changes
    • Differential Diagnosis of Pregnancy - Objective Changes
    • Changes of Pregnancy
      Diagnostic (positive) changes
      Fetal heartbeat
      Fetal movement
      Visualization of the fetus
    • Pregnancy Tests
      Urine tests
      Hemagglutination-inhibition test (Pregnosticon R test)
      Latex agglutination test (Gravindex and Pregnosticon Slide tests)
      The first two are done on first early morning urine specimen
      Positive within 10 to 14 days after the first missed period
      Detect hCG during early pregnancy
    • Pregnancy Tests
      Serum tests
      -subunit radioimmunoassay: Positive a few days after presumed implantation
      Immunoradiometric assay (IRMA) (Neocept, Pregnosis); requires only about 30 minutes to perform
      Enzyme-linked immunosorbent assay (ELISA) (Model Sensichrome, Quest Confidot): Detects hCG levels as early as 7 to 9 days after ovulation and conception, 5 days before the first missed period
      Fluoroimmunoassay (FIA) (Opus hCG, Stratus hCG); takes about 2 to 3 hours to perform; used primarily to identify and follow hCG concentrations
    • Pregnancy Tests
      Over-the-Counter pregnancy tests
      Enzyme immunoassay tests
      Performed on urine
      Detect even low levels of hCG
      Can detect a pregnancy as early as first day of missed period
      Negative result, test may be repeated 1 week if period has not occurred
    • Mother’s Emotional and Psychological Changes
      First trimester: Disbelief and ambivalence
      Second trimester: Quickening; helps mother to view fetus as separate from herself
      Third trimester: Anxiety about labor and birth; nesting (bursts of energy) occurs
    • Mother’s Emotional and Psychological Changes (cont’d)
      Rubin’s four tasks: Ensuring safe passage through pregnancy, labor, and birth
      Seeking acceptance of this child by others
      Seeking commitment and acceptance of herself as mother to infant
      Learning to give of oneself on behalf of one’s child
    • Father/Partner’s Emotional and Psychologic Changes
      First trimester
      May feel left out
      May be confused by his partner’s mood changes
      Might resent the attention she receives
      Second trimester: Begins to decide which behaviors of own father he wants to imitate or discard
      Third trimester: Anxiety about labor and birth
    • Family’s Emotional and Psychologic Changes
      May view baby as threat to security of their relationships with parents
      Reaction depends on age of siblings
      Preparation for birth is essential
      Usually supportive
      Excited about the birth
      May be unsure about how deeply to become involved
    • Cultural Assessment
      Main beliefs
      Traditions of the family
      Behaviors about pregnancy and childbearing
      Helps to explore woman’s (or family’s) expectations of healthcare system
      Allows nurse to provide care that is appropriate and responsive to family needs
    • Cultural Factors
      Factors that will impact the family’s plans for the pregnancy
      Religious preferences
      Communication style
      Common etiquette practices
      Ethnic background
      Amount of affiliation with the ethnic group
      Patterns of decision making>
    • Assignment
      Draw the female internal reproductive anatomy. Label each organ, and list the changes that occur in each organ system(note book).
    • Antepartal Nursing Assessment
    • Learning Objectives
      Summarize the essential components of a prenatal history.
      Define common obstetric terminology found in the history of maternity clients.
      Identify factors related to the father’s health that are generally recorded on the prenatal record.
      Describe areas that should be evaluated as part of the initial assessment of psychosocial and cultural factors relatedto a woman’s pregnancy.
      Describe the normal physiologic changes one would expect to find when performing a physical assessment of apregnant woman.
      • Compare the methods most commonly used to determine the estimated date of birth.
      • Develop an outline of the essential measurements that can be determined by clinical pelvimetry.
      • Delineate the possible causes of the danger signs of pregnancy.
      • Relate the components of the subsequent prenatal history and assessment to the progress of pregnancy.
    • Prenatal History
      Details of current pregnancy
      First day of last normal menstrual period (LMP)
      Presence of complications
      Attitude toward pregnancy
      Results of pregnancy tests, if completed
      Presence of discomforts since LMP
      Number of pregnancies and number of living children
      Number of abortions, spontaneous or induced
    • Prenatal History
      History of previous pregnancies
      Length of pregnancy
      Length of labor and birth
      Type of birth
      Type of anesthesia used (if any)
      Woman’s perception of the experience
      Complications associated with childbirth
      Neonatal complications
    • Prenatal History
      Gynecologic history
      Date of last Pap smear - any history of abnormal Pap smear
      Previous infections: Vaginal, cervical, tubal, or sexually transmitted
      Previous surgery
      Age at menarche and sexual history
      Regularity, frequency, and duration of menstrual flow
      History of dysmenorrhea and contraceptive history
    • Prenatal History
      Current medical history
      General health: Weight, nutrition, and regular exercise program
      Blood type and Rh factor, if known
      General health: Nutrition and regular exercise program
      Medications and use of herbal medication use during pregnancy
      Previous or present use of alcohol, tobacco, or caffeine
      Illicit drug use and drug allergies and other allergies
    • Prenatal History
      Current medical history
      Potential teratogenic insults to this pregnancy
      Presence of disease conditions such as diabetes
      Immunizations (especially rubella)
      Presence of any abnormal symptoms
    • Prenatal History
      Past medical history
      Childhood diseases
      Past treatment for any disease condition
      Surgical procedures
      Presence of bleeding disorders or tendencies (Has she received blood transfusions?)
    • Prenatal History
      Family medical history
      Presence of chronic or acute systemic diseases
      Complications associated with childbirth: Preeclampsia
      Occurrence of multiple births
      History of congenital diseases or deformities
      Occurrence of cesarean births and cause, if known
    • Prenatal History
      Religious preference and religious beliefs related to health care and birth:
      Prohibition against receiving blood products
      Dietary considerations or circumcision rites
      Practices that are important to maintain her spiritual well-being
      Practices in her culture or that of her partner that will influence care
    • Prenatal History
      Occupational history: Physical demands of present job
      Partner’s history: Genetic conditions and blood type
      Woman’s demographic information
      Age, educational level
      Ethnic background
      Socioeconomic status
    • Common Obstetric Terminology
      Gravida: Any pregnancy, regardless of duration, includes the current pregnancy
      Parity: Birth after 20 weeks’ gestation; infant may be born alive or dead
    • Common Obstetric Terminology (cont’d)
      T: Number of term infants born
      P: Number of preterm infants
      A: Number of pregnancies ending in either spontaneous or therapeutic abortion
      L: Number of currently living children
    • FIGURE 10–1 The TPAL approach provides detailed information about the woman’s pregnancy history.
    • Common Obstetric Terminology (cont’d)
      Gestation: Number of weeks since the first day of the last menstrual period
      Abortion: Birth occurring before the end of 20 weeks’ gestation
      Term: Normal duration of pregnancy (38 to 42 weeks’ gestation)
      Antepartum: Time between conception and the onset of labor
      Intrapartum: Period from the onset of true labor until the birth of the infant and placenta
    • Common Obstetric Terminology (cont’d)
      Postpartum: Time from birth until the woman’s body returns to prepregnant condition
      Preterm or premature labor: Labor that occurs after 20 weeks’ but before completion of 37 weeks’ gestation
      Nulligravida: Woman who has never been pregnant
      Primigravida: Woman pregnant for the first time
    • Common Obstetric Terminology (cont’d)
      Nullipara: Woman who has had no births at more than 20 weeks’ gestation
      Primipara: Woman who has had one birth at more than 20 weeks’ gestation
      Multipara: Woman who has had two or more births at more than 20 weeks’ gestation
      Stillbirth: Infant born dead after 20 weeks’ gestation
      Multigravida: Woman in second or any subsequent pregnancy
    • Father’s Information
      Existing medical conditions
      History of chronic illness - father or immediate family member
      Blood type and Rh factor
      Current use of recreational drugs
    • Father’s Information (cont’d)
      Present use of tobacco and alcohol
      Genetic disorders
      Educational level
      Methods by which he learns best
      Attitude toward the pregnancy
    • Cultural and Psychosocial Factors
      Language preference
      Religious preference
      Socioeconomic status
      Psychological status
      Educational needs
      Support system
    • Cultural and Psychosocial Factors (cont’d)
      Determine food preferences
      Determine significant people to client - assess degree of involvement of those people
      Assess family functioning
      Level of involvement
      Stability of living conditions
      Be aware of the practices of various cultural groups
    • Complementary Care (Yoga)
    • Normal Physiological Changes
      Pulse may increase by 10 beats per minute
      Respiration may be increased and thoracic breathing predominant
      Temperature and blood pressure within normal limits
      Weight varies: Should be proportional to the gestational age of the fetus
      Nose: Nasal stuffiness
      Chest and lungs: Transverse diameter greater than anterior-posterior diameter
    • Normal Physiological Changes (cont’d)
      Linea nigra
      Striae gravidarum
      Spider nevi
      Mouth: Gingival hypertrophy
      Neck: Slight hyperplasia of thyroid in the third trimester - small, nontender nodes
    • Normal Physiological Changes (cont’d)
      Increasing size
      Pigmentation of nipples and areola
      Tubercles of Montgomery enlarge
      Colostrum appears in third trimester
    • Normal Physiological Changes (cont’d)
      Progressive enlargement
      Fetal heart rate heard at approximately 12 weeks’ gestation
      Extremities: Possible edema late in pregnancy
      Spine: Lumbar spinal curve may be accentuated
      Pelvic area: Vagina without significant discharge
    • Normal Physiological Changes (cont’d)
      Cervix closed
      Uterus shows progressive growth
      Laboratory tests
      Physiologic anemia may occur (decrease in hemoglobin and hematocrit)
      Small degree of glycosuria may occur
    • Commonly Used Methods
      Nägele’s rule
      Begin with the first day of the LMP
      Subtract 3 months, and add 7 days
      Physical Examination - fundal height: Measurement of uterine size
      Ultrasound: Method used to measure fetal parts
      Crown-to-rump measurements
      Biparietal diameter (BPD) measurements
    • FIGURE 10–2 The EDB wheel can be used to calculate the due date. To use it, place the “last mensesbegan” arrow on the date of the woman’s LMP. Then read the EDB at the arrow labeled 40. Inthis case the LMP is September 8, and the EDB is June 17.
    • FIGURE 10–3 A cross-sectional view of fetal position when McDonald’s method is used to assess fundalheight.
    • FIGURE 10–4 Listening to the fetal heartbeat with a Doppler device.
    • Pelvic Measurements
      Pelvic inlet
      Diagonal conjugate
      Measure at least 11.5 cm
      Obstetric conjugate - 10 cm or more
    • A
      FIGURE 10–5 Manual measurement of inlet and outlet. A, Estimation of the diagonal conjugate, whichextends from the lower border of the symphysis pubis to the sacral promontory. B, Estimationof the anteroposterior diameter of the outlet, which extends from the lower border of the symphysis pubis to the tip of the sacrum. C and D, Methods that may be used to check the manual estimation of anteroposterior measurements.
    • B
      FIGURE 10–5 (continued) Manual measurement of inlet and outlet. A, Estimation of the diagonal conjugate, whichextends from the lower border of the symphysis pubis to the sacral promontory. B, Estimation of the anteroposterior diameter of the outlet, which extends from the lower border of the symphysis pubis to the tip of the sacrum. C and D, Methods that may be used to check the manual estimation of anteroposterior measurements.
    • C
      FIGURE 10–5 (continued) Manual measurement of inlet and outlet. A, Estimation of the diagonal conjugate, whichextends from the lower border of the symphysis pubis to the sacral promontory. B, Estimationof the anteroposterior diameter of the outlet, which extends from the lower border of the symphysis pubis to the tip of the sacrum. C and D, Methods that may be used to check the manual estimation of anteroposterior measurements.
    • Pelvic Measurements
      Pelvic outlet
      Anteroposterior diameter
      Should be 9.5 to 11.3 cm
      Transverse diameter should be 8 to 10 cm
    • FIGURE 10–6 Use of a closed fist to measure the outlet. Most examiners know the distance between their first and last proximal knuckles. If they do not, they can use a measuring device.
    • Signs of Infection or Cancer
      Elevation in vital signs
      Urine with elevated white blood cells
      High white blood cell count in the blood
      Lesions in the genital area
      Excessive malodorous vaginal discharge
      Positive tests for sexually transmitted infections
    • Signs of Infection or Cancer
      Tender, hard fixed nodes in the neck
      Abnormal lung sounds
      Breast lumps
      Nipple discharge
      Redness and tenderness of breast tissue
    • Signs of Anemia or Cardiopulmonary Problems
      Pale mucous membranes
      Skin pallor
      Signs of nutrition deficiency
      Low hemoglobin and hematocrit levels
      Elevations in blood pressure
      More than expected weight gain
    • Signs of Cardiopulmonary Problems
      Abnormal lung sounds
      Increased respiratory rate
      Abnormal heart rhythm
      Extra heart sounds
    • Other Danger Signs
      Less than expected weight gain
      Petechiae or bruises
      Inflamed gingival tissue
      Enlarged thyroid
      Abdominal tenderness or mass
      Lack of peripheral pulses
    • Other Danger Signs
      Failure to detect fetal heart rate
      Abnormal spinal curves
      Hyperactive reflexes
      Below normal pelvic measurements
    • Danger Signs in Pregnancy
    • Danger Signs in Pregnancy (cont’d)
    • Subsequent Prenatal Assessment
      Prenatal visits
      Every 4 weeks for the first 28 weeks’ gestation
      Every 2 weeks until 36 weeks’ gestation
      After week 36, every week until childbirth
    • Subsequent Prenatal Assessment
      Assessments during prenatal visits
      Vital signs and weight
      Uterine size and fetal heartbeat
      Blood tests for AFP, glucose
      Vaginal swab for group B strep
      Expected psychological stage of pregnancy
    • Activity:
    • Documentation
      Document within context of nursing practice
      Example: Music therapy for the child having acute pain
      Cristina Marie M. Manzano RN, RM, MAN
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