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    Virtual Eli - Maternity Nursing Virtual Eli - Maternity Nursing Presentation Transcript

    • INCREDIIBLY EASY OBSTETRIC NURSING
    • MCN UPDATES.
      • BEMOC  Basic Emergency Obstetric Care
      • CEMOC  Critical Emergency Obstetric Care
    • BEMOC
      • 6 functions of BEMOC:
      • 1 st  PARENTAL ADMINISTRATION of OXYTOCIN in the 3 rd stage of labor
      • 2 nd  PARENTERAL ADMIN of LOADING DOSE of ANTI-CONVULSANTS
      • 3 rd  PARENTERAL ADMIN of INITIAL DOSE of Abx
      • 4 th  Performance of assisted deliveries
    • BEMOC
      • 5 th removal of retained products of conception
      • 6 th manual removal of retained palcenta
    • CEMOC
      • 6 functions + assisting in CS and providing BT
    • ESSENTIAL PROCEDURES in OB
      • ALPHA-FETO PROTEIN
      • Purpose:
      • To assess the presence of neural tube defects and Down syndrome
      • Indication:
      • Increase AFP  NEURAL TUBE DEFECT
      • Decrease AFP  DOWN’s SYNDROME
    • IMPORTANT NOTES on AFP:
      • AFP  is a GLUCOPROTEIN produced by fetal yolk sac, GI tract and liver
      • test is done between 16 and 18 weeks of gestation
    • AMNIOCENTESIS
      • Purpose:
      • To assess the fetal growth and maturity, and to determine the genetic disorders and sex of the fetus.
      • NOTES:
      • test done between 14-16 weeks  to assess the chromosomal aberrations
      • test done after 35 weeks  to assess the fetal lung maturity
    • Important notes of amniocentesis
      • VOID first
      • Position  SUPINE
      • L/S ratio  2:1 indicates fetal lung maturity
      • Advise the client to report:
        • fetal hyperactivity
      • COMPLICATIONS: placental, cord and bladder puncture
    • BIOPHYSICAL PROFILE
      • To assess:
        • FETAL BREATHING MOVEMENTS – (0-2)
        • BODY MOVEMENTS – (0-2)
        • MUSCLE TONE – (0-2)
        • REACTIVE HEART RATE – (0-2)
        • AMNIOTIC FLUID – (0-2)
      • To identify  ASPHYXIA
    • CHORIONIC VILLI SAMPLING
      • PURPOSE:
      • To determine the chromosomal or genetic disorders in the fetus. It is the earliest test possible on fetal cells.
      • Sample obtained by SLENDER CATHETER passed through the cervix.
    • CONTRACTION STRESS TEST
      • PURPOSE:
      • to determine that a HEALTHY FETUS can withstand DECREASED O2 during contraction but a COMPROMISED FETUS CANNOT.
    • Important notes In cst:
      • 2 types:
      • Nipple-stimulated CST:
      • - Massage or rolling of nipples
      • - check the FHR
      • OCT (Oxytocin challenge test)
      • - “piggy-back”
      • - controlled by infusion pump
      • - increase every 15-20 minutes until 3 good contractions in 10 minutes
    • FETAL MOVEMENT COUNT
      • Notes:
      • - 5-6 movements per counting time.
      • - teach the mother to count 2-3 times daily
      • - 30-60 minutes each time
    • FETAL HEART MONITORING
      • Early deceleration
      • Indication: FETAL HEAD COMPRESSION
      • What to do: NONE
      • Late deceleration
      • Indication: PLACENTAL INSUFFICIENCY
      • What to do: Administer o2
      • Variable deceleration
      • Indication: CORD COMPRESSION
      • What to do:
      • - lateral recumbent pos and give o2
    • GUTHREI CAPILLARY BLOOD TEST
      • PURPOSE:
      • To screen PKU
      • NV: 2mg/dL
      • What to do:
        • Give high protein diet 24-24 hours BEFORE the test
    • HYSTEROSALPHINGOGRAPHY
      • PURPOSE:
        • Check PATENCY
      • NOTES:
        • done in PRE-OVULATORY PHASE
        • contraindicated in pregnancy (bcoz of dye)
    • LEOPOLD’s MANEUVER
      • POSITION:
        • DORSAL RECUMBENT  to relax the abdomen
      • NOTES:
        • Warms hands
        • Use pal not fingers
        • 1 st maneuver: FETAL PRESENTATION
        • 2 nd maneuver: FETAL BACK and FHR
        • 3 rd maneuver: ENGAGEMENT
        • 4 th maneuver: FETAL ATTITUDE
    • NOTES on LM:
      • 1 st ,2 nd ,3 rd maneuver  facing the HEAD PART
      • 4 th maneuver  facing the FOOT PART
    • Lecithin/sphingomyelin
      • NOTES:
        • To assess FETAL LUNG MATURITY
        • 35-36 weeks lungs is at mature level
        • If not mature, what to do?  give BETAMETHASONE (as ordered)
    • Non-stress test
      • PURPOSE:
        • To assess the fetal activity and well being
      • NOTES:
        • REACTIVE TEST: NORMAL FHR + >15 bpm = 15 mins or more
        • NON-REACTIVE TEST: NORMAL FHR + <15 bpm = 15 minutes  INDICATION: FETAL JEOPARDY
        • ACCELERATONS of HR means NORMAL
        • Monitor FHR in 30 minutes
    • PUBS
      • PERCUTANEOUS UMBILICAL BLOOD SAMPLING
      • PURPOSE:
        • to locate umbilical cord and detect chromosomal abnormalities
      • NOTES:
        • Do not void before the procedure
        • Use during 2 nd and 3 rd trimister
    • SWEAT CHLORIDE TEST
      • PURPOSE:
        • To detect CYSTIC FIBROSIS
      • NOTES:
        • Normal CHLORIDE level: 90-110 mg/dL(serum)
        • Normal SWEAT level: 10-35 mEq/L
        • >60 mEq/L of SWEAT means CYSTIC FIBROSIS
    • LOCHIA
      • RIYADH-SAUDI-ARABIA
      • RUBRA-SEROSA-ALBA
      • RUBRA (reddish)  1-3 days
      • SEROSA (brownish/pinkish)  4-10 days
      • ALBA (whitish)  10-14 days  up to 3 weeks – 60 days
    • OB PHARMA
      • Dimercaprol  ANTIDOTE in LEAD POISONING  Give IM
      • BETAMETHASONE  for fetal lung maturity  give 48 hrs before delivery
      • MAGNESIUM SULFATE  ANTICONVULSANTS
        • Monitor 3 signs  DTR, U/O, RR
      • PITOCIN (Oxy)  Oxytocic  induce labor
    • OB PHARMA
      • RhoGAM  prevents ERYTHROBLASTOSIS FETALIS
      • VITAMIN K  prevent fetal bleeding
      • YUTOPAR (Ritrodrine)  TOCOLYTIC
        • Relax UTERUS
    • 4 stages of human sexual response
      • 1 st EXCITEMENT
        • ARTERIAL DILATION and VENOUS CONSTRICTION
      • 2 nd PLATEAU
        • CBQ  REACHED FIRST BEFORE ORGASM
        • Women: Formation of ORGASMIC PLATFORM and NIPPLE ENGORGEMENT
        • Men: FULL DISTENSION OF PENIS
      • 3 rd ORGASM
        • Discharge
        • CBQ  SHORTEST STAGE
      • RESOLUTION
        • External and Internal organs return to unaroused state
        • Generallt takes 30 MINUTES
    • MENSTRUAL CYCLE
      • MENSTRUAL
      • PROLIFERATIVE
      • SECRETORY
      • ISCHEMIC
    • PHASES of menstrual cycle
      • MENSTRUAL
        • 1-5 days
        • LOW ESTROGEN
      • PROLIFERATIVE
        • 6-14 days
        • HIGH ESTROGEN
        • THICK ENDOMETRIUM
        • CLEAR MUCUS
      • SECRETORY
        • 15-24 days
        • HIGH PROGESTERONE
        • INCREASE BLOOD FLOW TO THE UTERUS
      • ISCHEMIC
        • 25-28 days
        • DECREASED ESTRO and PROGESTERONE
        • MENSTRUATION BEGINS
    • IMPORTANT NOTES
      • 2-5 days  average menstruation days
      • 30-40 mL avergae blood loss
      • 40-45 years old  start MENOPAUSAL
      • 55 years old  start of TESTOSTERONE declines
    • FUNCTIONS OF HORMONES Estrogen Progesterone 1. inhibits FSH release 1. inhibits LH release 2. cause proliferation of endometrial lining 2. increases vascularity in the uterus 3.  cervical mucous production (+ spinnbarkeit) 3. maintains the course of pregnancy 4. causes water retention
    • FETAL GROWTh
      • OVUM  from ovulation - fertilization
      • ZYGOTE  from fertilization - implantatn
      • EMBRYO  from implantation-5-8 weeks
      • FETUS  5-8 weeks to term
      • CONCEPTUS
    • SIGNS and symptoms of pregnancy
      • PRESUMPTIVE SIGNS
        • Amenorrhea
        • Breast changes
        • QUICKENING
        • N&V
        • Urinary Frequency
    • SIGNS and symptoms of pregnancy
      • PROBABLE SIGNS
        • Abdominal changes
        • Hegar’s sign
        • Goodell’s sign
        • Uterine growth
        • Ballotement
        • Braxton’ Hicks Contraction
        • Chadwicks sign
    • SIGNS and symptoms of pregnancy
      • POSITIVE SIGNS
        • Fetal parts
        • UTZ
        • FHR
    • MASTERY DRILL
      • Abdominal striae
      • Amenorrhea
      • Balotement
      • Braxton’s Hicks contraction
      • Breast tenderness
      • FHR
      • Goodell’s sign
      • Hegar’s sign
    • MASTERY DRILL
      • Nausea and vomiting
      • (+) pregnanct test
      • QUICKENING
      • UTZ
      • Urinary frequency
    • DISCOMFORT DURING PREGNANCY
      • Ankle edema
      • What to do: ELEVATE
      • Back ache
      • What to do: PELVIC ROCK EXERCISE
      • Breast tenderness
      • What to do: SUPPORTIVE BRA
    • DISCOMFORT DURING PREGNANCY
      • Constipation
      • What to do: Increase FLUID & FIBER
      • Dyspnea
      • What to do: HOB elevated
      • Fatiue
      • What to do: Frequent rest periods in between activities
    • DISCOMFORT DURING PREGNANCY
      • Constipation
      • What to do: WALKING
      • Ptyalism
      • What to do: CHEW sugarless gum
      • Leg cramps
      • What to do: DORSIFLEX the toes
      • Nasal stuffiness
      • What to do: Apply cool moist air
    • NOTES
      • Backache  relieved by using PELVIC ROCK EXERCISE
    • EXPECTED WT GAIN DURING PREGNANCY
      • TOTAL WEIGHT GAIN: 20-25 lbs
      • 1 st trimester:
      • - 1 lb /month  3-4 lbs total
      • 2 nd trimester:
      • - 0.90 lb / week  10-12 lbs total
      • 3 rd trimester:
      • - 0.50 lb / week  8-11 lbs total
    • NOTES
      • The pregnant women needs additional 300 calories per day
      • Lactating mother needs 500 calories per day
      • The pregnant FILIPINO client needs approximately 2140 calories/day
      • 3-4 servings/day of vegetables of pregnant
      • The pattern of weight gain is more important than the amount of weight gain
    • NOTES
      • IRON intake of 2 tablets/day  start at 5 th month to 2 months postpartum
      • CHLOROQUINE 2 tablets  for malarial infested areas in whole duration of pregnancy
      • 3-4 glasses of MILK/day  pregnant
      • HBMR  pink in color (pregnancy care package)
    • EXERCISES in PREGNANCY
      • PELVIC TILT
        • Backache
        • strengthen abdominal muscles
    • EXERCISES in PREGNANCY
      • TAILOR-SITTING
        • STRETCHES muscles of inner thigh
    • EXERCISES in PREGNANCY
      • SQUATTING position
        • Straighten the birth canal
    • EXERCISES in PREGNANCY
      • KEGEL’S EXERCISE
        • strengthens the PUBOCOCCYGEAL MUSCLES and PELVIC FLOOR MUSCLES
    • PRENATAL VISITS
      • 1  1-3 months
      • 1  4-6 months
      • 2  7 th month
      • 4  8-9 th months
    • FORMULAS
      • NAGELE’S RULE  determine EDC
        • -3 months
        • + 7 days
        • + 1 year
      • McDonald’s RULE  determines AOG
        • Start from 22 weeks to term
        • FH(cm) x 8/7 = AOG in weeks
        • FH(cm) x 2/7 = AOG in LUNAR MONTHS
    • EXAMPLE
      • LMP October 20, 2008, fundic height, 28 cm
        • EDC __________________
        • Ans: July 27,2009
        • AOG: ________________
        • Ans: 28 x 8/7
    • OB HISTORY
      • _______________ number of pregnancies regardless of outcome
      • _____________ number of pregnancy that reach the age of viability
    • OB HISTORY
      • G
      • P
      • T – erm ( 38-42 weeks)
      • P – re-term ( 20-37 weeks)
      • A – bortion ( before viablity)
      • L
      • M
    • EXAMPLE
      • This is my first pregnancy. I am on my 27 th week. I have not been pregnant before.
      • Ans: _____________________
      • 1-0-1-0-0
    • FALSE LABOR TRUE LABOR
      • F  IRREGULAR
      • P  confined to hospt’l
      • W – Releived by walking
      • BS - ABSENT
      • F – REGULAR
      • P – radiates from lumbo-sacral to abdomen
      • W- Intensified
      • BS  PRESENT
    • METHODS OF DELIVERY
      • READ METHOD
        • Classes in RELAXATION and ABDOMINAL BREATHING TECHNIQUES
      • LAMAZE METHOD
        • BREATHING, EFFLEURAGE, RELAXATION
      • LAMAZE METHOD
        • Husband-coached child birth
    • MECHanism OF LABOR
      • D
      • E
      • F
      • IR
      • E
      • ER
      • E
    • STAGES OF LABOR
      • FIRST STAGE OF LABOR
        • Onset of TRUE LABOR to FULL cervical diatation
        • LATENT  0-3cm
        • ACTIVE  4-7cm
        • TRANSITIONAL  8-10 cm
    • STAGES OF LABOR
      • LATENT
        • excited and happy
        • inform the progress of labor
      • ACTIVE
        • give narcotic analgesics
        • praise and encourage the client
      • TRANSITION
        • irritable, circumoral pallor
        • monitor the progress of labor
    • NOTES
      • If narcotic analgesic is given on transition stage it will cause RESPIRATORY DEPRESSION
      • Primiparas are normally not taken in the delivery room until the perineum is bulging
      • THE PRIMARY REASON OF EPISIOTOMY  help prevent prolonged pressure on fetal head
      • the NITRAZINE TEST -> to differentiate URINE and AMNIOTIC FLUID
    • NOTES
      • CROWNING occurs at the SECOND STAGE OF LABOR
      • in 2 nd stage of labor  encourage to PUSH DOWN
      • SIM’s position or KNEE CHEST pos  to lessen the pregnant client discomfort
      • to prevent RESPI ALKALOSIS  use PAPER BAG
    • NOTES
      • The UMBILICAL CORD is CLAMP  after no pulsation
      • clear the mucus in the MOUTH first then NOSE of the newborn
      • BONDING begins during the first hour of pregnancy
      • Eye drops  for PROPHYLAXIS  apply at LOWER CONJUNCTIVA
    • NOTES
      • FREQUENCY  beginning of contraction to the end of contraction
      • DURATION  beginning of first contraction to the beginning of second contraction
      • INTENSITY  mild, moderate and strong.  PEAK
    • NOTES
      • FHR normal 120-160. During contraction FHR DECREASES normally
      • FHR ausculation is done during NO UTERINE COTRACTION.
      • FHR ausculation is done also DURING UTERINE CONTRACTION but for 30 seconds only to identify the changes
    • ABORTION
      • Types of abortion:
        • Threatened
        • Inevitable
        • Complete
        • Incomplete
        • Missed
        • Septic
        • Recurrent/Habitual
    • INEVITABLE
      • Abdominal Pain
      • Ans: Moderate
      • Vaginal Bleeding
      • Ans: Moderate
      • Cervix
      • A ns: OPEN CERVIX
    • INCOMPLETE
      • Abdominal pain
      • Ans: SEVERE
      • Vaginal bleeding
      • Ans: SEVERE
      • Cervix
      • Ans: OPEN CERVIX
    • INEVITABLE / INCOMPLETE
      • Abdominal Pain
      • Ans: Moderate
      • Vaginal Bleeding
      • Ans: Moderate
      • Cervix
      • Ans: OPEN CERVIX
      • Abdominal pain
      • Ans: SEVERE
      • Vaginal bleeding
      • Ans: SEVERE
      • Cervix
      • Ans: OPEN CERVIX
    • HABITUAL/RECURRENT
      • 3 or more episodes of abortion
    • Threatened / INEVITABLE
      • Abdominal Pain
      • Ans: MILD
      • Vaginal Bleeding
      • Ans: MILD
      • Cervix
      • Ans: CLOSED CERVIX
      • Abdominal Pain
      • Ans: Moderate
      • Vaginal Bleeding
      • Ans: Moderate
      • Cervix
      • Ans: OPEN CERVIX
    • MASTERY DRILL
      • Moderate bleeding and open cervix
        • Ans: INEVITABLE
      • Mild bleeding and closed cervix
        • Ans: THREATENED
      • Severe bleeding and open cervix
        • Ans: INCOMPLETE
      • No fetal movement
        • Ans: MISSED
    • P.P A.P
      • Painless
      • BRIGHT RED BLEEDING
      • SOFT, BOGGY UTERUS
      • Types:
        • marginal
        • partial
        • total
      • Painful
      • DARK RED VAGINAL BLEEDING
      • BOARD-LIKE UTERUS
      • Types:
        • partial
        • marginal
        • total
        • central
    • GESTATIONAL HPN
      • Occur AFTER 20 th week
      • signs  EDEMA of hands  “RING FINGER”
      • 2 types:
      • PRE-ECLAMPSIA
        • proteinuria
        • BP increased
        • EDEMA/wt gain
      • ECLAMPSIA  3 s/sx + CONVULSION
    • WHAT TO DO:
      • CBR
      • DARKENED ROOM
      • INCREASED PROTEIN
      • Left lateral position
      • Increase UTERINE and RENAL blood flow
      • Administer MgSO4 as prescribed
        • DTR INCREASED
        • RR DECREASED
        • U/O DECREASED
    • CARDIAC DISEASES
      • CLASS I  no signs of discomfort
      • CLASS II  ordinary physical activity may result in discomfort
      • CLASS III  little activity cause discomfort
      • CLASS IV  discomfort experience at rest
    • RUBIN’s POST PARTUM PHASE
      • TAKING-IN PHASE
        • 1-3 days
        • mother is “SELF-CENTERED”
      • TAKING HOLD
        • 3 days – 2 weeks
        • mother is “INDEPENDENT”
      • LETTING GO
        • 10 days/2 weeks to 6 weeks
        • mother integrates her new role
    • NOTES
      • CRYING and INSOMIA  are common manifestations of post-partum blues
      • 4 th -5 th day  onset of post partum blues
      • perineal pad is saturated within an hour  HEAVY LOCHIAL DISCHARGE
      • PAIN in the perinea  most common symptom of perineal hematoma
      • SITZ BATH  most common method for relieving discomfort from episiotomy
    • NOTES
      • The correct method of cleaning the perineum is from FRONT to BACK
      • BREAST ENGORGEMENT  usually occurs on the 3 rd post partum day.
    • notes
      • Fever  >38 degrees on day 2 to 10 is the important sign of post partum infection
      • Blood loss of 500 mL or more during and after delivery (first 24 hours)
      • DIC  occur at 24 hours and within 7-14 days post partum
    • NOTES
      • Elevation of mother’s temperature 24 hours after delivery  NORMAL
      • BRADYCARDIA after delivery is normal
      • the FUNDIC HEIGHT decrease 1 fingerbreadth or 1 cm per day
    • CCOMPOSITION OF MILK
      • 1 st week of lactation
        • Colustrum  High IgA
      • 7-10 days after lactation
        • TRANSITIONAL MILK  Low IgA
      • After 2 weeks of lactation
        • MATURE MILK  has 20 kcal/oz nutrients for infants needs
    • FAMILY PLANNING METHOD
      • Cervical mucus  bawal magjerjer from first day to 4 th day of slippery dischrages
      • BBT
        • avoid sex from 1 st day – 3 rd day of menstrual bleeding
      • SYMPTOTHERMAL
        • BBT + CERVICAL SECRETIONS
    • FAMILY PLANNING METHOD
      • LAM
        • 6 months only
        • BREASTFEEDING  8-10 times a day
      • ORAL CONTRACEPTIVES
        • s/e IRREGULAR BLEEDING, MISSED PERIODS and REDUCE MILK PRODUCTION
      • DEPO
        • 3 months effective
        • contain PROGESTIN
        • Changes in vaginal bleeding is normal
    • FAMILY PLANNING METHOD
      • NORPLANT
        • place in UPPER ARM 8-10 cms above elbow crease
        • 5 years effective
        • effective 24 hours after insertion
        • s/e  HIRSUTISM, wt loss
    • FAMILY PLANNING METHOD
      • BTL
        • permanent
        • reversal surgery is possible but DIFFICULT
        • before surgery  NPO
        • after surgery  REST, avoid sex for at least 1 week
        • REPORT if  high fever in 4 weeks
    • FAMILY PLANNING METHOD
      • Vasectomy
        • permanent
        • STERILITY is NOT IMMEDIATE
        • fully effective only 20-25 ejaculations or 1-3 months
    • FAMILY PLANNING METHOD
      • IUD
        • check the IUD on the first month of insertion
        • How to check  SQUATTING position  insert 1-2 fingers into vagina  feel the strings
    • FAMILY PLANNING METHOD
      • Vaginal methods
        • spermicide, diaphragm, cervical cap
        • spermicides  1 hour before sex
        • diaphragm or cervical cap  ahead of time before sex
        • AVOID DOUCHING 6 hours AFTER
        • use of CERVICAL CAP may affects the result of Pap’s smear
    • notes
      • SMOKING  is contraindicated if taking ORAL CONTRACEPTIVES
      • cervical cap  requires refitting by a physician every 2 years. After delivery or after weight gain or weight loss 15-20 lbs
      • Visit www.virtualeli.net for more NLE updates.