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 that deals with childbirth

- it deals with durationPregnancy 38-42

weeksLabor & Delivery 20 hoursPuerperium 6-8 weeks

- It deals with 2 clients1. mother2. fetus

Menstrual Disorders Infertility Contraception/ Family Planning Menopause

The best managed care principles value a comprehensive approach that focus on:

*Preventionex: 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 Organsp.47 Fig. 3 - 1

Ovary - Cortex, medulla ovulation(4cm long) endocrine

Uterus - Fundusmenstruation

(3X2X1) Corpus gestationCervix

Fallofian - InfundiberlumTubes Ampulla Fertilization4 inches Intramus Passageway

Interstitial

UTERUS- Pear shaped- 3 Layers

1. endometrum2. myometrum3. perimetrium

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

- Broad, Cardinal, uterosacral

- Ovarian cycle Follicular maturation

of follicles Intral ovulation

- Endometrial Cycle ProliferativeSecretorymenstrual

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

BrainHypothalamus GnRH -stimulates the APG

to secrete gonodo- trophic Hormones

BrainAPG FSH -Responsible for

maturation of Follicles

Ovary 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

BrainAPG 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 Progesterone

Responsible for secretory 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 cycleEx. 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 – Blastocys Inner 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. Respiratory2. Nutritive3. Excretory4. Barrier – Bacteria, Virus5. 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 700-800ml

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 vein LiverInferior Vena Cava

thru Ductus Venosus

Right Atrium Foramen Ovale left ventricleAorta

From the superior vena cava right atrium

right ventricle pulmonary arteryductus Enterrosins Aortaby 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 formed32 weeks – Subcutaneous fat

- Fingernails and toenails-Descend of testes begins

38 weeks – Term baby

Uterus non-pregnant – 60gms pregnant -

1000gms capacity - 10ml -5000ccHypertrophy (Largely)Hyperpalasia (Limited)Stimulated by E and P

Braxton Hicks – starting 4th month * stimulates movement of blood thru the

spaces of the placentaCervix

*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 of mucosa

Loosened 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 be present (yellowish, AB rich)

RESPIRATORY SYSTEMSlight hypervilationSlight increase in RRDiaphragm is elevated due to enlarging uterus

Breathing may become thoracic than abdominal

Nasal stuffiness and congestionEpistaxis 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 20-24 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 SYSTEM

Total 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 TRACT

Higher urinary frequency due to growing uterus

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

Glycosuria is common

Amino Acids and water soluble vitamins are excreted in greater amounts

SKIN AND HAIR

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

Chloasma

Striae or stretch mark

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

Weight 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 T P A L 1 1 1 3

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 cell- may favor neoplastic cells.

Weight – 25 lbs

BP

Urine testing for preotein, glucose and albumin

FH measurement

F 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 = To confirm presentation and Engagement

4th Maneuver = To determine attitude

Hygiene of Pregnancy

Minor 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