Maternal Nursing- Ob

MATERNAL NURSING (OB)



MCN -

- Traditionally refers to care of women during pregnancy Birth and postpartum as well as the care of infants Children and adolescents. Specifically tasked complexities in health care has nurses to be maternal and women’s health care practitioners, nurse and midwives etc.

OBSTETRICS – Science with childbirth - it deals with Pregnancy Labor & Delivery Puerperium 

-

It deals with 2 clients 1. mother 2. fetus

that deals duration 38-42 weeks 20 hours 6-8 weeks

Menstrual Disorders  Infertility  Contraception/ Family Planning Menopause 

The best managed care principles value a comprehensive approach that focus on: *Prevention ex: mammograms, SBE, cervicacancer, screening, cervical vaccines, prenatal care, smoking cessation programs, healthy lifestyle, food choices etc. *Early Intervention *Continuity of Care

Vagina

– connects external to internal reproductive organ - It is a tube with rugae, distensible - Copulation and passage way - 3-4 inches long - Acidic, due to its normal flora - Ph – 4-5- average

Internal Reproductive Organs p.47 Fig. 3 - 1

Ovary (4cm long) 

 Uterus

-

Fundus Corpus Cervix

-

Infundiberlum Ampulla Intramus Interstitial

(3X2X1)

Fallofian Tubes 4 inches

Cortex, medulla

ovulation endocrine menstruation gestation

Fertilization Passageway

 -

UTERUS Pear shaped 3 Layers 1. 2. 3.

-

endometrum myometrum perimetrium

50-60gms weight Antenor rectum Posterior to the bladder Ligaments -

Broad, Cardinal, uterosacral

-

Ovarian cycle Follicular Intral

-

Endometrial Cycle  Proliferative Secretory menstrual

maturation of follicles ovulation

Monthly shedding of the uterine lining  Ave onset =12years – menarche  Ave duration =50-52 years- menopause  Ave amount =50ml (30-80ml)  Ave cycle =28 days  Menstrual blood consists of endometrial cells, blood, mucus unfertilized ovum 

 Menorrhagia  Dysmenorrhea  Amenorrhea  menopause

Organs

Hormones Functions

Brain Hypothalamus

GnRH

Brain APG Ovary

-stimulates the APG to secrete gonodo- trophic Hormones

FSH

-Responsible for maturation of Follicles

Estrogen -Responsible for *development of ducts of the breasts *spinnbarkeit secretions

Organs

Hormones

Functions

Uterus

Estrogen

Responsible for *proliferation of the endometrial glands *endometrium increases in thickness Contracts uterus

Brain APG

LH

Responsible for the rupture of the follicle

Ovary

Progesteron -Responsible for development of the Acini cells of the breast -thick mucus secretion *relaxes the uterus

Organs

Hormones Functions

Uterus

ProgesteroResponsible for secretory ne phase *Endometrium becomes more thickened, more vascular and glandular *Preparedness for implantation

 Produced

by the endometrium  Technically not a hormone because they are produced by tissues rather than special glands  Play a role in rupturing the grafian follicle  Large amount of prostaglandins are found in the menstrual blood  Found to have a contracting effect on the uterus

 Ovulation

occurs 14 days in a 28 day cycle  To get the approximate ovulation day, subtact 14 from the cycle  Ex.

Cycle is d32 days – 14 = 18th day

WOMAN

MAN

One ovum

Millions of sperms

22 chromosomes

Around 200-300M to effect fertilization, but only one to fertilized the ovum

And X sex chromosome

22 chromosomes and Y sex chromosome

24 hours viability

72 hours viability

Fertilization

takes place in the ampulla of the fallopian tube

Union

of sperm and ovum forms a zygote (46 chromosomes)

Zygote

continues to form a MORUL (16cells)



Morula – BlastocysInner cell mass Embryo

ammion

Outer cell Mass trophoblast Chorionic Villi Decidua Basalis PLACENTA  Implantation occurs 7 to 10 days after conception

 Organ

of metabolic and nutrient exchange between the embryonic and maternal circulation – begins 3rd week of embryonic development

 Weight

– 400 to 600gms

 Diameter

– 15 to 20 cm (8in)

 Average:

1 inch thick

Maternal

Fetal

Cotyledons

Membranes

 Chorion  amnion

1. 2. 3. 4. 5.

Respiratory Nutritive Excretory Barrier – Bacteria, Virus Endocrine - HCG, HPL, Estrogen & Progesterone

 Functions:  Acts

as a cushion to protect against mechanical injury  Maintains a constant temperature  Acts as a nudge during labor  Ph

is alkaline and contains L,S, bilirubin, vernix, Lanugo, epithelial cells, albumin



After 20 weeks, ranges between 700800ml

 Fetus

contributes to volume of amniotic fluid by excreting urine

 Fetus

swallows up to 600ml every 24 hours and about 400ml flows out of fetal lungs each day

 Umbilical

Liver Inferior Vena Cava thru Ductus Venosus

 Right

 From

vein

Atrium

Foramen Ovale Aorta

left ventricle

the superior vena cava right atrium right ventricle pulmonary artery ductus Enterrosins Aorta by passing the lungs

4

weeks – Heart begins to beat  8 weeks – all body organs are formed  8-12 weeks – FHB- heard by doppler  16 weeks – Sex can be seen  20 weeks – FHB – heard by stethoscope - quickening - baby has patterns of sleep, sucking, kicking - vernix and lanugo are present

24

weeks – Fetal respiratory movements begin 28 weeks – Eyes begin to open and close - Head hair, eyebrows and eyelashes are present surfactant is formed 32 weeks – Subcutaneous fat - Fingernails and toenails -Descend of testes begins 38 weeks – Term baby

 Uterus 

non-pregnant – 60gms

capacity -5000cc  Hypertrophy

- 10ml

(Largely)  Hyperpalasia (Limited)  Stimulated by E and P

pregnant -1000gms

 Braxton

Hicks – starting 4th month

* stimulates movement of blood thru the spaces of the placenta  Cervix

*Goodells *Chadwicks - higher glandular cell glands leading to leukorrhea



OVARIES Cease

to function

Corpus

luteum covers 1/3 of ovary and is maintained by HCG which will persist and produce hormones until placenta takes over

VAGINA 

Hypertrophy

Hyperplasia Vascularization

Results in:  Thickening  Loosened

of mucosa

connective tissue

 Higher

vaginal secretions (thick, white, acidic Ph 3.5 to 6.00)

 Chadwick’s

SX



BREASTS Higher

in size

Nipples

erectile

Pigmented

areola

Montgomary

tubercles

Colostrum-may

rich)

be present (yellowish, AB



RESPIRATORY SYSTEM Slight

hypervilation Slight increase in RR Diaphragm is elevated due to enlarging uterus Breathing may become thoracic than abdominal Nasal stuffiness and congestion Epistaxis may occur



CARDIOVASCULAR SYSTEM Heart

is pushed upward and to the

left Systolic murmur cab be heard in most pregnant women Blood Volume progressively higher to about 40-50% above non-pregnant level. Cardiac output higher and peaks 2024 weeks

CARDIOVASCULAR

SYSTEM

BP

may decrease especially 2nd trimester and returns to its prepregnant level at term.

Uterine

pressure on the vanal cava when the woman is supine results in supine hypotensive syndrome.

CARDIOVASCULAR Total

SYSTEM

RBC volume higher by 18%-30%

Plasma

volume increase is 50% but HCT lower slightly, which causes physiologic anemia of pregnancy

Higher

WBC production

Fibrinogen

higher by as much as 50%



GASTROINTESTINAL SYSTEM N

and V (HCG effect)

Ptayalism Heart

burn

Gastric

emptying time is delayed leading to bloating and constipation

hemorrhoids

URINARY Higher

uterus

TRACT

urinary frequency due to growing

Glomerular

Filtration Rate(GFR) higher by as much as 50%

Glycosuria Amino

is common

Acids and water soluble vitamins are excreted in greater amounts

SKIN

AND HAIR

Higher

Pigmentation – areola, nipples, vulva, perianal area, linea alba

Chloasma Striae Sweat

or stretch mark

and sebaceous glands are hyperactive

MUSCULOSKELETAL

SYSTEM

Sacroiliac,

sacrococcygeal and pubic joints of the pelvis relax – (waddling gait)

Postural

changes (lordosis)

CENTRAL

NERVOUS SYSTEM

Sleep

problems

Mood

swings

Depression PICA

Most metabolic functions accelerate during pregnancy in support to the additional demands of the growing fetus, the mother’s tissue replacement needs and in preparation to labor and lactation.



Normal

 Weight

=25-30 lbs. =11-13 kg.

Gain Distribution -5kg.(11lbs) -Fetus, placenta AF - .9kg(2lbs) -uterus -1.8kg(4lbs) -Blood volume -1.4kg(3lbs) -Breasts -2.3-4.5kg -Maternal stores (5-10lbs.)

Braxton Hicks

Nausea & Vomitin

FAB

Ballotement

Chadwick’s

Pregnancy Test

Skin Changes

Amenorrhea

Breast enlargement

UTZ visualization

Hegar’s nsx

Breast tenderness

According to Reva Runin (1984) there are tasks that a woman must accomplish to incorporate the maternal role successfully into her being. 1. Ensuring

a safe passage throughout pregnancy and

birth *Participation in positive self care activities related to diet, exercise and over-all well being

2.

Seeking acceptance of infant by others

3.

Seeking acceptance of self in maternal role to infant (binding in) *mother acknowledges fetus as a separate being w/in her – wit her experience of quickening

4.

Learning to give of oneself * what must be given up to assume new role



Ambivalence - conflicting feelings, considered normal

Introversion

- focusing on oneself-common during early pregnancy - woman becomes passive to her family and friends



Acceptance - generally, wnd trimester feeling

Mood

scrimp - feels, great joy, cry, disbelief etc.

 Promotion

of the health and well being of a woman and her partner before pregnancy.

GOAL: Identify any areas such as health problems, lifestyle habits or other concerns that might unfavorably affect pregnancy.

GOAL: Healthy mother for a healthy baby Frequency. 1-7 months =

monthly

8 months

=

2x moth

9 months

=

weekly

TERMS: Gravida

-

# of pregnancy regardless of outcome

Para

-

# of pregnancy that has reached viability

Multigravida-

a woman who has never been pregnant

OB Scoring -

GP (TPAL)

 Example:

Juanita is pregnant and visits you at the PNC. She had one ectopic pregnancy at 8 weeks. She has one baby born at 39 weeks and one born at 32 weeks which is a set of twins. What is her OB Score? Answer:

G4P2

TPAL 1113

 DATA

– - Age, G, P, AOG - OB HX - Medical Hx

 P.E.

- Vital signs - Weight and Height - Head to toes Assessment *Head, Breast, Abdomen, Genitals, Extremities, IE *FH and Leopold’s Maneuver

 Laboratory

Test

-

Urine

-

Blood

-

Pap smear- negative, organisms, presence of squamous cells or glandular cellmay favor neoplastic cells.



Weight – 25 lbs

 BP  Urine  FH F

testing for preotein, glucose and albumin

measurement

Movement

 FHR

- A procedure that is performed to determine presentation, position and lie. First Maneuver = To determine presentation 2nd Maneuver =

To determine position

3rd Maneuver = Engagement

To confirm presentation and

4th Maneuver =

To determine attitude

 Hygiene  Minor

of Pregnancy

Discomforts

 Danger

Signs

 Teratogens  Exercises  Nutrition

Nutrient

NP

Present

Lactation

Calories

2,200

2,500

2,700

Protein

60 gms

80 gms

80 gms

Folate

400 mcg

600 mcg

500 mcg

Iron

18mg

27mg

9mg

Calcium

1000g

1000g

1000g