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Prenatal Care


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Prenatal Care

  1. 1. Sexual and Reproductive Anatomy and Physiology
  2. 2. OVERVIEW • The functions of the human reproductive system are multifold. • The male's reproductive role is to manufacture male gametes called sperm and deliver them to the female reproductive tract. • The female produces female gametes called ova or eggs. The female also provides an environment for a fertilized ovum, a zygote, to develop. • Both the male and the female produce sex hormones that affect sexual behavior, drive, development and function.
  4. 4. The Female External Genitalia
  5. 5. A. Mons pubis or Mons Veneris – a pad of fat which lies over the symphysis pubis covered by skin and at puberty by short hairs; protects the surrounding delicate tissues from trauma Stages of Pubic Hair Development (Tanner Scale) Stage 1 Pre Adolescence – No pubic hair except for fine body hair Stage 2 Occurs b/w ages 11 and 12 – Sparse, long, lightly pigmented and curly hair develops along labia
  6. 6. • Stage 3 Occurs between ages 12 and 13 – hair becomes darker and curlier that develops along pubic symphysis • Stage 4 Occurs between ages 13 and 14 – assumes the normal appearance of an adult but is not so thick and does not appear to the inner aspect of the upper thigh • Stage 5 Sexual Maturity – assumes the normal appearance of an adult and appear to the inner aspect of the upper thigh
  7. 7. B. Labia majora – Two folds of skin with fat underneath; contains bartholins’s glands which are believed to secrete a yellowish mucus which acts as a lubricant during sexual intercourse. The openings of bartholin’s glands are located posteriorly on either side of the vaginal orifice.
  8. 8. • C. Labia minora – two thin folds of delicate tissues; form an upper fold encircling the clitoris ( called the prepuce) and unite posteriorly (called the fourchette) which is highly sensitive to manipulation and trauma that is why it is often torn during a woman’s delivery.
  9. 9. • D. Glans clitoris – small erectile structure at the anterior junction of the labia minora, which is comparable to the penis in its being extremely sensitive.
  10. 10. • E. Vestibule – narrow space seen when the labia minora are separated. Almond shape area that contains the hymen, vaginal orifice and bartholin’s glands. a. Urinary Meatus – external opening of the urethra; serves for urination b. Skene’s glands – 2 small mucus secreting substances that serves for lubrication
  11. 11. c. Hymen – membranous tissue that covers the vaginal orifice (* Carumculae Mestiformes – healing of torn hymen) d.Bartholin’s glands/ Para vaginal gland – secretes alkaline substance, which neutralizes the acidity of the vagina. (doderleins bacillus – controls the acidity of vagina)
  12. 12. • F. Urethral Meatus – External opening of the urethra; slightly behind and to the side are the openings of the Skene’s glands (which are often involved in infections of the external genitalia) STD. • G. Vaginal orifice or Introitus – external opening of the vagina covered by a thin membrane (called hymen) in virgins.
  13. 13. • h. Perineum _ area from the lower border of the vaginal orifice to the anus; contains the muscles (pubococcygeal and levator ani muscles) which support the pelvic organs, the arteries that supply blood to the external genitalia and the pudendal nerves which are important during delivery under anesthesia.
  15. 15. A. Vagina – a 3 – 4 inch long dilatable canal located between the bladder and the rectum; contains rugae (which permit considerable stretching without tearing); organ of copulation; passageway for menstrual discharges and fetus.
  16. 16. B. Uterus • Shape: Non Pregnant – Pear shaped/ Pregnant – Ovoid shape • Weight: Nonpregnant - 50 – 60 gram • Pregnant - 1000 gram • 4th stage of labor – 1000 gram • 2 weeks after delivery – 500 grams • 3 weeks after delivery – 300 grams • 5 – 6 weeks after delivery – 50 – 60 grams
  17. 17. – Hollow pear shaped fibromuscular organ 3 inches long 2 inches wide 1 inch thick and weighing 50 – 60 grams in a non-pregnant woman – Held in place by broad ligaments ( from the sides of uterus to pelvic walls; also hold fallopian tubes and ovaries in place) and round ligaments (from the sides of uterus to the mons pubis) – Abundant blood supply from uterine and ovarian arteries
  18. 18. Composed of 3 muscle layers: which makes expansion possible in every direction. • Endometrium – in lines the non pregnant uterus (inner), muscle layer for menstruation ( * Endometriosis – ectopic endometrium abnormal growth of endometrial lining outside the uterus….common site ovaries. s/sx. Persistent dysmenorrheal and lowback pain) • Myometrium – the largest part of the uterus; the muscle layer for pregnancy; its smooth muscles is considered to be the living ligature of the body • Perimetrium – protect the entire uterus
  19. 19. – Consist of three parts – Corpus (body) – upper portion with a triangular part called fundus – Isthmus – area between corpus and cervix which forms part of the lower uterine segment – Cervix – lower cylindrical portion
  20. 20. –organ of menstruation; site of implantation; retainment and nourishment of the products of conception.
  21. 21. C. Fallopian Tubes – 2-3 inches long that serves as a passageway of the sperm from the uterus to the ampulla or the passageway of the mature ovum or fertilized ovum from the ampulla to the uterus
  22. 22. 4 significant segments • 1. Infundubulum – most distal part of fallopian tube (tunnel or trumphet shape) • 2. Ampulla – outer 3rd and half; site of fertilization; common site of ectopic pregnancy; widest part spreads into fingerlike projections called Fimbrae. • 3. Isthmus – common site of fertilization; site for BTL • 4. Interstitial – the most dangerous site of ectopic pregnancy
  23. 23. D. Ovaries – almond – shaped, dull white sex glands near the fimbrae, kept in place by ligaments. • - produce mature ovum and expel ova and manufacture estrogen and progesterone • - for ovulation
  24. 24. • Blood supply to the ovaries is primarily from the ovarian arteries, which are branches of the abdominal aorta. Blood is drained from the ovaries via the ovarian veins. • An ovary is surrounded externally by a tunica albuginea, similar to that found upon the testis. • The ovary has an outer cortex, which contains the forming gametes, and an inner medulla, which contains large blood vessels and nerves. • The ovarian cortex is quite vascular and contains multiple tiny ovarian follicles. Each follicle contains an immature egg, an oocyte, surrounded by one or more layers of cells.
  25. 25. Anatomy of the Vagina and Vulva • The vagina is a thin-walled tube, 3-4 inches long, that extends from the cervix to the body exterior. • It lies between the bladder and the rectum. • The vaginal wall has three tunics: an outer fibroelastic adventitia, a smooth muscle muscularis, and a rugae-containing stratified squamous mucosa.
  26. 26. • The vaginal orifice is the external opening of the vagina. • In virgins, the mucosa near the orifice forms an incomplete partition called the hymen. • The upper portion of the vaginal canal surrounds the cervix of the uterus, producing a recess called the vaginal fornix. • The vaginal orifice is adjacent to many structures of the external genitalia.
  27. 27. Anatomy of the Female Breast (Mammary Gland)
  28. 28. • The mammary glands are present in both sexes, but normally only function in females. • The mammary glands sit within the breasts, within the superficial fascia and anterior to the pectorals. • Slightly below the center of each breast is a ring of pigmented skin, the areola, which surrounds the central protruding nipple.
  29. 29. • Internally, each mammary gland consists of 15-25 lobes that radiate around and open up at the nipple. The lobes are separated from one another by connective tissue and fat.
  30. 30. • This connective tissue forms suspensory ligaments that attach the breast to the underlying muscle and overlying dermis. • Within the lobes are smaller units called lobules, which contain glandular alveoli that produce milk during lactation. • The alveolar glands pass the milk into the lactiferous ducts, which open at the nipple. Just deep to the areola, each duct contains a dilated region called the lactiferous sinus, where milk accumulates during nursing.
  31. 31. Male Reproductive Anatomy and Physiology
  32. 32. II. Male Reproductive System • includes the penis, scrotum and testes (encased in the scrotal sac) • spermatozoa are produced in the testes and reached maturity, surrounded by semen, in the external structures.
  33. 33. 2
  34. 34. • Semen is derived from the prostate gland (60%), seminal vesicle (30%), the epedidymis (5%) and the bulbourethral glands (5%) • Semen is alkaline and contains a basic sugar and mucin (protein)
  35. 35. Male External Structures 1. Penis – the male organ of copulation and urination. It contains of a body or a shaft consisting of 3 cylindrical layers and erectile tissues. At its tip is the most sensitive area comparable to that of the clitoris in the female – the Glans Penis.
  36. 36. • The penis and the scrotum collectively make up the external genitalia. • The function of the penis is to deliver sperm into the female reproductive tract during copulation. The penis consists of an attached root, a shaft, and an enlarged tip called the glans penis. • The skin covering the penis is loose, and at the glans there is a cuff called the prepuce, or foreskin, which is typically removed at circumcision.
  37. 37. • The penis contains three erectile bodies: the corpus spongiosum and two corpora cavernosa. • The corpus spongiosum is ventral and surrounds the urethra. The corpora cavernosa are dorsal. • Each of these erectile tissues consists of a network of connective tissue and smooth muscle filled with vascular sinuses.
  38. 38. 3 cylindrical Layers • 1. 2 Corpora Cavernosa • 2. Corpus spongiosum
  39. 39. 2. Scrotum – a pouch hanging below the pendulous penis, with a medial septum dividing into two sacs, each of which contains a testes • - it contains the testes, epididymis and the lower portion of the spermatic cord. • - it support the testes and help regulate the temperature of sperm it requires 2 degrees celcius for spermatogenesis
  40. 40. 3. Testes – 2 ovoid glands 2 – 3 cm wide that lie in the scrotum - encased by a protective white fibrous capsule - composed of a number of lobules - each lobule containing interstitial cells (Leydig’s cell) and Semeniferous Tubules - Semeniferous tubules produced spermatozoa - Leydig’s cell produce male hormone testosterone
  41. 41. Anatomy of the Sperm
  42. 42. The process of Spermatogenesis 1.Hypothalamus 2.GnRH 3.APG 4.FSH – stimulate the release of androgen Binding Protein for sperm maturation LH – stimulate Leydig’s cell which responsible for the release of testosterone ABP binding testosterone promotes spermatogenesis
  43. 43. 5.Testes (Semeniferous tubules) 6.Epididymis (6m long coiled tubules/ site for sperm maturation) 7.Vas deferens (pathway of spermatozoa) 12.Urethra
  44. 44. 8.Seminal Vesicle (secretes fructose prostaglandin) 9.Ejaculatory duct 10.Prostate Gland 11.Cowpers Gland (bulbourethral Gland)
  45. 45. Epididymis – a tightly coiled tube, approximately 20 ft. long • responsible for conducting sperm from the testis to the vas deferens • sperm are immobile and incapable of fertilization as they pass or are stored at the epididymis level. • It takes at least 12 -20 days for them to travel the length of the epididymis and a total of 64 days for them to reach maturity
  46. 46. Vas Deferens (Ductus deferens) – it carries sperm from the epididymis through the inguinal canal into the abdominal cavity, where it ends at the seminal vesicles and the ejaculatory ducts. • sperm matures as they pass thru the vas deferens
  47. 47. Bulbourethral Gland – lies beside the prostate gland and by short ducts empty into the urethra • Secretes alkaline fluid that helps counteract the acid secretion of the urethra and ensure the safe passage of spermatozoa.
  48. 48. Urethra - a hollow tube leading from the base of the bladde, which after passing through the prostate gland, continues to the outside through the shaft and glans penis. • 8 inches long, lined with mucous membrane.
  49. 49. Seminal vesicles – two convoluted pouches that lie along the lower portion of the bladder • empty into the urethra by way of ejaculatory ducts • secretes a viscous portion of the semen, with high content of a basic sugar, protein, and prostaglandins and is alkaline. • Sperm become increasingly motile
  50. 50. Ejaculatory Ducts – pass through the prostate gland and join the seminal vesicles with the urethra Prostate Gland – chestnut – sized gland that lies just below the bladder. • the urethra passes through the center of it. • Secretes a thin alkaline fluid
  51. 51. Male and Female Homologues Male Female • Penile Glans Clitoral Gland • Penile shaft Clitoral shaft • Testes Ovaries • Prostate Skene’s Glands • Cowpers Glands Bartholins Glands • Scrotum Labia majora
  52. 52. Basic Knowledge on Genetics and Obstetrics • DNA carries genetic information • Chromosomes thread like strands composed of hereditary materials composed of DNA. • Normal amount of ejaculated sperm is 5 -3 cc • ovum is capable of being fertilized within 24 – 36 hours after ovulation • Sperm is viable within 48 – 72 hours / 2-3 days
  53. 53. • Reproductive cells divides by the process of meosis 1.spermatogenesis – maturation of sperm 2.Oogenesis – maturation of ovum 3.Gametogenesis – process of maturation of haploid to diploid • Age of Reproductivity is 15 – 44y/o • Ideal age for child bearing 20 - 30 • With risk 18 –2 0 • With high risk 31 – 35
  54. 54. Menstruation • Mestrual cycle – beginning of menstruation to beginning of the next menstruation • Average Mestrual Cycle – 28 days • Normal Blood loss - 50 cc • Related terminologies: • Menarche – Ist menstruation • Dysmenorrhea – painful menstruation • Metrorrhagia – bleeding in between menstruation • Menorhagia – excessive bleding during menstruation • Amenorrhea – absence of menstruation • Menopaus – cessation of menstruation • Oligomenorrhea – markedly diminished menstrual flow, nearing amenorrhea • Polymenorrhea – frequent menstruation occurring at intervals of less than 3 weeks.
  55. 55. Functions of Estrogen and Progesterone ESTROGEN “hormone of the woman” – Primary functions: development of secondary sex characteristics/ inhibits FSH production/ Hypertrophy of myometrium – Others: • early closure of the epiphysis of long bones • Inhibits FHS production • hypertrophy of myometrium • increases quantity and PH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of 10 – 13 cm. ( spinbarkheit test of ovulation) • Ductile structure of the breast • Na retention • increase sexual desire • vaginal lubrication
  56. 56. – PROGESTIN/ PROGESTERONE • “hormone of the Mother” • Primary function: prepares the endomertium for implantation of ovum • Secondary function: Inhibits uterine contractility • Others: • Inhibits LH production ( for ovulation) • Decrease GIT motility, increase reabsorption (causes constipation) • increase permeability of kidneys to lactose and dextrose causing positive 1 sugar. • Mammary gland dvlopment • Increase Basal Body Temperature
  57. 57. Female pelvis and measurements The Pelvis- although not a part of the female reproductive system but of skeletal system. It is a very important body part of pregnant women. A. Structure 1.Two os coxae/ innominate bones – made up of : – Ilium – upper extended part; curved upper border is the iliac crest – Ischium – under part; the body rsts on the ischial tuberosities; ischial spines are important landmarks – Pubes – front part; join to form an articulation of the pelvis called the symphysis pubis
  58. 58. 2.Sacrum – wedge – shaped, forms the back part of the pelvis. Consist of 5 fused vertebrae, the first having a prominent upper margin called the sacral promontory. The sacroiliac joint is the articulation between the sacrum and the ilium. 3.Coccyx – lowest part of the spine; degree of movement between sacrum and coccyx made possible by the third articulation of the pelvis sacroccyeal joint which allows room for delivery of the fetal head.
  59. 59. B. Divisions – set apart by the linea terminals, an imaginary line from the sacral promontory to the ilia on both sides to the superior portion of the symphysis pubis. 1.False Pelvis – superior half formed by ilia; offers landmarks for pelvic measurements; supports the growing uterus during pregnancy; and directs the fetus into the true pelvis near the end of gestation. It also supports the abdominal viscera. 2.True Pelvis – Inferior half formed by the pubes in front; the iliac and ischia on the sides and the sacrum and coccyx behind. Made up of 3 parts:
  60. 60. 2.1 Inlet – entrance way to the true pelvis. Its transverse diameter is wider than its anteroposterior diameter. • - transverse diameter = 13.5 cm • - anteroposterior diameter (AP) = 11 cm • - Right and Left oblique diameter = 12.75 cm 2.2 Cavity – space between the inlet and the outlet. Contains the bladder and the rectum, with the uterus between them in an anteflexed position towards the bladder 2.3 Outlet – inferior portion of the pelvis bounded on the back by the coccyx on the sides by the ischial tuberosities and in front by the inferior aspect of the symphysis pubis and the pubic arch. Its AP diameter is wider than its transverse diameter.
  61. 61. C. Types / Variation 1.Gynecoid – normal female pelvis. Inlet is well rounded forward and back. Most ideal for child birth. 2.Anthropoid – transverse diameter is narrow AP diameter is larger than normal. Oval shaped. 3.Platypelloid – inlet is oval, AP diameter is shallow, wide transverse diameter but short AP diameter, making the outlet inadequate. 4.Android – Male Pelvis; not favorable for labor. Inlet has a narrow, shallow posterior portion and pointed anterior portion
  62. 62. D. Measurements 1. External – suggestive only of pelvic size. 1.1 Intercristal diameter – distance between the middle points of the iliac crest. Average = 28 cm. 1.2 Interspinous diameter – distance between the anterosuperior spines. Average = 25 cm 1.3 Intertrochanteric diameter – distance between the trochanters of the femur. Average = 31 cm 1.4 External conjugate / baudelocques diameter – distance between the anterior aspect of the symphysis pubis and depression below L5. average = 18 – 20 cm
  63. 63. 2. Internal - give the actual diameters of the inlet and outlet 2.1 Diagonal Conjugate – distance between the sacral promontory and inferior margin of the symphysis pubis. Average = 12.5 cm 2.2 True conjugate / conjugate vera – distance between the anterior surface of sacral promontory and the superior margin of the symphysis pubis. Very important measurement because it is the diameter of the pelvic inlet. Average = 10.5 – 11 cm 2.3 Bi – ischial diameter/tuberischii – transverse diameter of the pelvic outlet is measured at the level of the anus. Average = 11 cm.
  64. 64. Feedback Mechanism of Mestruation A. General considerations • 300,000 – 400,000 immature oocytes per ovary are present at birth ( were formed during the first 5 months of intrauterine life, a process called oogenesis); many of these oocytes, however, degenerates and atrophy ( a process called atresia). Only about 300 – 400 mature during the entire reproductive cycle of women. • .
  65. 65. • Ushered in by the menarch (very first menstruation in girls) and ends with menopause (permanent cessation of menstruation); age of onset and termination vary widely depending on heredity, racial background, nutrition and even climate
  66. 66. • Normal period (days when there is menstrual flow) last for 3 – 6 days; menstrual cycle (from first day of menstrual period up to the first day of the next menstruation period) may be anywhere from 25-35 days, but accepted average length is 28 days. • Anovulatory states after menarche are not unusual because of immaturity of feedback mechanism. Anovulatory states also occur in pregnancy, lactation and related disease conditions.
  67. 67. • Body structures involved – Hypothalamus – Anterior Pituitary Gland – Ovary – Uterus • Hormones which regulate cyclic activities – Follicle stimulating hormone – Leutenizing hormone
  68. 68. sequential steps in the menstrual Cycle 4 phases of the menstrual cycle • 1. Proliferative Phase (6-14 days) • 2. Secretory Phase (15 – 26 days) • 3. Ischemic Phase (27 28 days) • 4. Menses (1 – 5 days)
  69. 69. A. On the third day of the menstrual cycle, serum estrogen level is at its lowest. This low estrogen level serves as the stimulus for the hypothalamus to produce the follicle stimulating hormone releasing factor (FSHRF). B.FSHRF is the one responsible for stimulating the Anterior Pituitary Gland to produce the first of two hormones which regulate cyclic activities, the FSH.
  70. 70. C. FSH in turn, will stimulate the growth of an immature oocyte inside a primordial follicle by stimulating production of estrogen by the ovary. Once estrogen is produced, the primordial follicle is now termed as Graafian follicle ( the Graafian follicle, is the structure which contains high amounts of estrogen)
  71. 71. D. Estrogen in the graafian follicle will cause the cell in the uterine endothelium to proliferate (grow very rapidly), thereby increasing its thickness to about eightfold. This particular phase in the uterine cycle therefore, is called Proliferative phase.
  72. 72. In view of the change from primordial to graafian follicle, it is also called follicular phase. Because of the predominance of estrogen it is also called the estrogenic phase. And since it comes right after the menstrual period, it is also called postmenstrual phase. It is also called Pre-ovulatory
  73. 73. E. On the 13th day of the menstrual cycle, there is now a very low level of progesterone in the blood. This low serum progesterone level is the stimulus for the hypothalamus to produce the Leutenizing hormone releasing factor (LHRF). F. LHRF is responsible for stimulating the APG to produce the second hormone which regulates cyclic activity, the Leutenizing Hormone.
  74. 74. G. The Lh, in turn is responsible for stimulating the ovary to produce the second hormone produced by the ovaries, Progesterone.
  75. 75. H. The increase amounts of both estrogen and progesterone push the new mature ovum to the surface of the ovary until, on the following day (14th day of the menstrual cycle) the graafian follicle ruptures and releases the mature ovum, a process called Ovulation
  76. 76. I. Once ovulation has taken place, the graafian follicle, because it now contains increasing amounts of progesterone, giving it its yellowish appearance, is termed Corpus Luteum. ( Therefore the structure which contains high amounts of progesterone is the corpus luteum)
  77. 77. A. Progesterone causes the glands of the uterine endothelium to become corkscrew or twisted in appearance because of the increasing amount of capillaries.  Progesterone therefore, is said to be the hormone designed to promote pregnancy because it makes the uterus nutritionally abundant with blood in order for the fertilized zygote to survive should conception take place, that is why this phase in the uterine cycle is what we call Progestational phase.
  78. 78. Also called Secretory Phase because it secretes most important hormone in pregnancy. In view of the change from Graafian follicle to corpus luteum, it is also called luteal phase. And also called the pre-menstrual phase.
  79. 79. K Up until the 24th day of the menstrual cycle, if the mature ovum is not fertilized by a sperm, the amounts of hormones in the corpus luteum will start to decrease.
  80. 80. The corpus luteum turning white is now called the corpus albicans and in 3 – 4 days the thickened lining of the uterus produced by estrogen starts to degenerate and slough off and capillaries rupture. And thus begins another menstrual period.
  81. 81. Stages of Sexual Response • Initial Responses – VASOCONSTRICTION – congestion of blood vessel – Myotonia – Increase muscle tension • EXCITEMENT PHASE – Increase muscle tension – Moderate increase in HR, RR, BP – Nipple erection – Penile erection – During this phase erotic stimuli cause an increase in sexual tension – May last from minutes to hours
  82. 82. • PLATEAU PHASE –Accelerated vital sign –Increasing and sustained tension nearing orgasm –Lasting from 30 seconds – 3 minutes
  83. 83. • ORGASM – diminished sensory assessment ( peak VS) – Involuntary release of sexual tension accompanied by physiologic and psychologic release of – Known as the immesurable peak of sexual experience – Last for 2 – 3 seconds – Pelvic area is the most affected area
  84. 84. • RESOLUTION – Vital sign may return to normal – The most critical part – Cardiac problem may occur • Refractory period – the only period present in males, wherein he cannot be restimulated for about 10 – 15 minutes
  85. 85. The Heart: Nursing Patient with Congestive Heart Failure
  86. 86. OBJECTIVES: A. To identify and learn the different vital structures and functions of the Heart B. To define and better understand the mechanism of Congestive Heart Failure
  87. 87. C. To enumerate and learn the risk factors and etiologic processes leading to Right and Left Congestive Heart Failure. D. To identify and integrate preventive - curative measures by applying Medical and Nursing Interventions in the management of patient with CHF.
  88. 88. FUNCTIONS OF THE HEART 1. To pump oxygenated blood to the arterial system, which carries it to the cells. 2. To collect deoxygenated blood from the venous system and deliver it to the lungs for reoxygenation.
  89. 89. Structures of the Heart
  90. 90. The Anatomy of the Heart
  92. 92. Blood Flow
  93. 93. The Conduction System of the Heart
  95. 95. Nursing People Experiencing Congestive Heart Failure
  96. 96. Congestive Heart Failure: Defined (Cardiac Decompensation, Ventricular Failure, Cardiac Insufficiency) The Inability of the Heart to pump enough blood to meet the metabolic needs of the body at rest or during exercise
  100. 100. FAILURE OF RIGHT VENTRICLE BACKWARD EFFECTS Increased volume in systemic venous circulation Increased volume in distensible organ Hepatomegaly and splenomegaly Dependent edema and serous effusion FORWARD EFFECTS Expansion of blood volume Decreased volume to lungs
  101. 101. FAILURE OF THE LEFT VENTRICLE BACKWARD EFFECTS Increased volume and pressure in L ventricle and atrium Increased volume in pulmonary veins Pulmonary edema FORWARD EFFECTS Decreased cardiac output Decreased perfusion of body tissues Decreased blood flow to kidneys and glands Increased secretion of sodium and water retaining hormones Increase reabsorption of sodium and water
  102. 102. ASSESMENT OF CHF LEFT VENTRICULAR FAILURE A. Dyspnea or shortness of breath B. Orthopnea C. Paroxysmal Nocturnal Dyspnea D. Cheyne-Stokes respiration E. Pulmonary edema F. Cough G. Cerebral Hypoxia H. Fatigue and Muscular weakness I. Cardiovascular sign ( pulsus alternans, S3 heart sound) J. Renal Changes ( oliguria)
  103. 103. Right Ventricular Failure • Peripheral edema and venous congestion • Cardiac Cirrhosis (ascites, jaundice, symptoms of liver damage) • Anorexia, nausea, and bloating (abominal Distention) • Cyanosis of the nail beds • Jugular vein distention • Hepatomegaly • Weight gain
  104. 104. Goals and major intervention in the management of CHF 1. Improve ventricular pump performance. a. Administer Inotropic agent (digitalis) b. Administer oxygen therapy 2. Reduce myocardial workload a. Reduce Preload 1. Administer diuretics 2. Restrict fluid and sodium intake 3. Place person in upright position 4. Reduce blood volume with phlebotomy b. Reduce Afterload 1. Administer vasodilators 2. Reduce Physical and emotional stress
  105. 105. Nursing Diagnosis and Intervention in Patient with CHF A. Alteration in cardiac output; decreased due to mechanical and structural defects of the heart. Interventions Assess BP, Pulse, CVP every 2 to 4 hours Weigh daily Monitor intake and output carefully Monitor electrolytes specially potassium and Na Avoid extracirculatory overload through excessive oral or IV fluid intake Allay thirst from fluid restriction with good oral care and hard candies
  106. 106. Interventions Promote bed rest Provide a bedside commode Administer stool softener and give instructions not to strain with defecation Give frequent small meals instead of three large meals daily Space Nursing Activities Create a relaxing environment