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0he
mos
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imp
orta
&t
topi
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a
+re&
atal
+reme&strual
Sy&drome
6me&orrhea (e&orrha"i
a
(etrorrha"ia
16
MALE CONDOMIUDD
/eHuires withdrawal of the pe&is
from the va"i&a before /elies
o& absti&e&ce from i&tercourse
duri&" fertile period-.dema of
lower e1tremities- +rimary-
-8le1ible device i&serted i&to the
uteri&e cavity
-!t alters uteri&e tra&sport of the
sperm so fertili2atio& do&Et
occur
,AN-$ SI-NS "O $PO"1
. Late or missed menstrual period
.Se#ere abdominal pain
.%e#er and chills
. %oul #a*inal dischar*e
.Spottin*3 bleedin*3 or hea#y
menstrual periods
. Spontaneous e@pulsion occur in
AB.9CB of users in the first
year
- /ubber sheath that fits
over the erect pe&is a&d
preve&ts sperm from
e&teri&" the va"i&a
- 5o&" polyuretha&e sheath
that is i&serted ma&ually
i&to va"i&a with a fle1ible
i&ter&al ri&" e1te&di&" to
cover the peri&eum
- 5ubricated with a
spermicide :&o&-o1y&ol-
A;
- !t ca& be i&serted up to =
hrs before i&tercourse
1. 1a''ie' Met#o(s
*EMALE CONDOM
:;AGINAL "OUCH;
eaculatio&
- 6bdomi&al bloati&"
- %ei"ht "ai&
- 7eadache
--reast te&der&ess
- ?epressio&
- 3ryi&"
- 5oss of co&ce&tratio&
*o '&ow& cause
- Seco&dary-
(ay be caused by
D (easured by ta'i&" &
recordi&" e temperature rally
rectally each mor&i&" before
wa'i&" after at least 3 hours of
sleep
D ?rops before ovulatio& a&d
rises B#2 8-B#= 8
In (asal body temperature
method the patient should ta8e
her temperature e#ery mornin*
upon a)a8enin* and prior to any
acti#ity to a#oid the temperature
bein* influenced by other factors.
D ,ses the appeara&ce,
characteristics a&d amou&t of
cervical mucus to ide&tify
ovulatio&
)vulatory< cervical mucus is clear
a&d abu&da&t
+re-ovulatory / post ovulatory<
cervical mucus is yellowish,
less abu&da&t, a&d stic'y
:i&hibit sperm motility;
.
D
3ou
ple
ma'
es
use
of
com
bi&at
io&
of
cale
&dar,
--0
, a&d
cervi
cal
muc
us
meth
od to
deter
mi&e
fertil
e
perio
d
1$
tumor/i&flammatory co&ditio&s
C 1et<een enst'ual c!clesD soe <oen e,&e'ience &ain
<#en t#e o)a'! 'eleases e$$
8i"ure 1-d 3o&dom
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NCLE@ TI"SEE
T#e feale con(o (u'in$ se,
*i$u'e %9(
?uri&" se1 the pe&is is i&serted i&to the ce&ter of the ope& ri&" at the ope&i&" of the va"i&a# ,&til both
part&ers are familiar with the /eality co&dom, the pe&is should be "uided by ha&d i&to the ope& ri&"#
)therwise there is the cha&ce that the pe&is will be i&serted outside the co&dom i&to the va"i&a, thus
defeati&" the co&domIs purpose# ,se of the male co&dom with the female co&dom is &ot recomme&ded,
because rubbi&" the late1 male co&dom a"ai&st the polyuretha&e female co&dom creates frictio& that may
ma'e i&tercourse difficult#
Reo)in$ t#e feale con(o
0he female co&dom should be removed followi&" i&tercourse a&d before sta&di&" up# 0o remove, sHuee2e
a&d twist the outer ri&" to e&sure that seme& remai&s i&side the co&dom# 4e&tly pull the co&dom from the
va"i&a# ?iscard i& the trash# ?o &ot attempt to flush the co&dom dow& the toilet, as it may clo" the toilet or
sewer li&es# ?o &ot reuse#
I&o'tant &oints to 'eebe' <#en usin$ t#e feale con(o
- "he female condom )or8s only if you use it e#ery time you ha#e se@.
. Use a ne) condom each time you ha#e se@ual intercourse. Do not reuse the %e+ale condo+.
. 5ou can still become pre*nant and transmit or ac4uire a se@ually transmitted disease )hile usin* the
female condom. "he ris8 is less than if you do not use the condom3 but there still is a sli*ht ris8.
. Althou*h the eality condom is prelubricated3 it also comes )ith a tube of lubricant in the pac8a*e. 5ou
may )ish to add a fe) drops of lubricant to the openin* of the condom or to the penis. Lubricants reduce
friction and noise those results from friction.
. emo#e tampons before insertin* the female condom.
. Use caution to a#oid tearin* the female condom )ith a sharp fin*ernail3 rin*3 or other ?e)elry )hen
insertin* and remo#in* the condom#
1=
"
H
R
A
G
M
C
*ot &ecessary for
repeated coitus,se
every
coitus3o&ti&uous
protectio& 24 hours
re"ardless of the
&umber of times of
se1ual i&tercourse)&
two hours prior to
se1ual i&tercourse a&d
i& place for 6 hours
after=BC with typical
use
S+./(!3!?.
,S64.
*,55!+6/6J=BC
(50!+6/6J6BC
?.S3/!+0!)*
Small rubber plastic that fits
s&u"ly over cervi1
8le1ible ri&" covered with dome shape
rubber cap
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F
3ervicitis
?,/60!)*
*ot lo&"er tha& 4= hours *ot lo&"er tha& 24 hours
A diaphra*m should be left in the #a*ina
:.; hours after se@ual intercourse.
Dia,hrag+A should remai& i& place 6-= hours after se1 & maybe left for 24 hours#
AL6A5S C+$C= %O "$AS < +OL$SDDD
#ontraindicated %or" %re4uent U"I3 Prolapsed Cord < etro#erted Uterus3 cystocele < rectocele3 acute
cer#icitis
*i$u'e 1-e ?iaphra"m
C. "#a'acolo$ic et#o(s
&ral #ontrace,tive Pill A sy&thetic estro"e& combi&ed with small amou&ts of sy&thetic pro"estero&e-
preve&ti&" ovulatio& by stoppi&" 8S7 & 57#
- Stops L+ < %S+
STO" I* ?ITH THE **< :637.S;
- A. abdominal pain3 #- Chest pain3 *. +eadaches3 E. eye problems < S.se#ere le* cramps
- A""N1 Se#ere +eadaches maybe an indication of +ypertensionDDDD
CONTRAINDICATEDA
9 "hromboembolism
A C&A3 +PN3 smo8in* < diabetics3,IC3 hyper#iscosity
#ontraindicated %or D)ABE.)#S. "he best for diabetics are (arrier Contracepti#es..Condom <
,iaphra*m
E$a+,les" ?emule& :.thi&yl .stradiol .thyl&odiol ; a mo&ophasic oral co&traceptive a"e&t.
If the patient for*ets to ta8e A tablets for the ne@t A days3 she should ta8e A tablets N$'" A ,A5SDDD
And use another contracepti#e method for the rest of the cycle.
If she misses E or more3 she should discard the remainin* tablets < use another contracepti#e
method for the rest of the cycle.
)/65 3)*0/3.+0!@.S(!*!+!55SS,-?./(65 !(+56*0SS,-3,06*.),S !*K.30!)*S,se to
preve&t co&ceptio& by i&hibiti&" ovulatio& :i&hibits release of 8S7 a&d 57;
3auses atrophic cha&"es i& the e&dometrium to preve&t impla&tatio& of e""
3auses thic'e&i&" of cervical mucus to i&hibit sperm travel
Under ideal conditions the sperm can reach the o#um 9 to F minutes after e?aculation.
3ombi&ed estro"e& a&d pro"estero&e preparatio& i& tablet form a&d are ta'e& daily with combi&atio&s of
hormo&es
22
Oral contracepti#es pre#ent pre*nancy by suppressin* %S+ 0follicle stimulatin* hormone7 and L+
0leuteni2in* hormone7 release from the pituitary *land thereby bloc8in* o#ulation.+ills co&tai& pro"esti& but &o
estro"e&
+ills must be ta'e& each day a&d preferably same time each day to achieve ma1imal effective&ess
0hi&s a&d atrophy e&dometrium a&d thic'e&s cervical mucous
6?@6*064.< ca& be use immediately postpartum if clie&t is &ot breastfeedi&" a&d 6 wee's if breastfeedi&"
6omen ta8in* the minipill ha#e a hi*her incidence of tubal and ectopic pre*nancies3 possibly because
pro*estin slo)s o#um transport throu*h the fallopian tubes. $ndometriosis3 female hypo*onadism3 and
premenstrual syndrome arenGt associated )ith pro*estin.only oral contracepti#es.Si1 soft sillastic rods filled
with sy&thetic pro"estero&e impla&ted i&to the woma&Es arm
+ro"estero&e lea's i&to the blood stream, i&hibiti&" impla&tatio& i&to e&dometrium
*orpla&t
!&serted subdermally i&to the midportio& of the upper arm about =-1Bcm above the elbow crease# 6 impla&table
capsules are i&serted at o&e time(edro1ypro"estero&e :?(+6 or ?.+)@./6;
Birth #ontrol Su++ar/ .a0le
-!/07 3)*0/)5 (.07)?6?@6*064./!SLS )/ +)SS!-5. +/)-5.(S
Spermicides< chemicals i& the form of
foams, creams, ellies, films, or
suppositories that are i&serted i&to the
va"i&a to 'ill sperm before they ca& e&ter
the uterus9 typical use effective&ess< $BC
M 6vailable over the cou&ter
M 3a& be used with other
methods to improve
effective&ess
M )&ly partially effective
a"ai&st se1ually tra&smitted
disease :S0?; tra&smissio&
M +ossible aller"ies or irritatio&
M *ot effective a"ai&st S0?
tra&smissio&M /eusable3ervical 3ap<
thimble-shaped late1 cap i&serted
i&to va"i&a over cervi1 to preve&t
sperm from e&teri&" uterus9 used
with spermicide9 typical use
effective&ess< =2CM *ot effective
a"ai&st S0? tra&smissio&M
/eusable3o&dom< male co&dom is a
sheath of late1 or a&imal tissue
placed o& erect pe&is9 female
co&dom is a plastic sac with a ri&"
o& each e&d i&serted i&to the va"i&a9
both may be used with a spermicide9
typical use effective&ess< =4C
:male; $AC :female;
M *eeds to be fitted by a health care
professio&al
M ?ifficult to fit wome& with a&
u&usual cervi1 si2e
M ?ifficult for some wome& to i&sert
M 3a& last for o&e to two years
C$&ICAL CAP< ca& be retai&ed upto 4=
hours# !t does &ot lea'# 3a&&ot be re-applied
a"ai& after use# (ay use spermicide before
use#
M .ffective a"ai&st S0?
tra&smissio&
M 6vailable over the cou&ter
M 3a& be used with other
methods to further protect
a"ai&st S0?
M +ossible aller"ies to late1 or
spermicide
M 5esse&s se&satio&
M (ay brea' duri&" i&tercourse
#A#oid usin* petroleum ?elly of
oil base productsH it can
cause INC$AS$ %IC"ION
)hich )ill lead to "$AIN-
O% "+$ LA"$' CON,OM#
23
M *eeds to be fitted by a health care
professio&al
M !&creased ris' of bladder i&fectio&
M +ossible aller"ies to late1 or
spermicide
M 3a& last for o&e to two years
-irth 3o&trol +ill< prescriptio& dru"
co&tai&i&" female hormo&es9 o&e pill ta'e&
daily preve&ts ovaries from releasi&" e""s
a&d/or thic'e&s cervical mucus to preve&t
sperm from reachi&" e""9 typical use
effective&ess< A4C?iaphra"m< shallow
late1 cup with fle1ible rim i&serted i&to
va"i&a over cervi1 to preve&t sperm from
e&teri&" uterus9 used with spermicide9
typical use effective&ess< =2C
M (ore re"ular periods
M *o actio& reHuired prior
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
M Some protection a*ainst
o#arian and endometrial
cancer3 noncancerous
breast tumors3 o#arian
cysts
M *ot effective a"ai&st S0?
tra&smissio&
M are but dan*erous
complications3 includin*
blood clottin* and
hypertension3 particularly in
)omen o#er EF years )ho
smo8e
M (ust be ta'e& daily
7ormo&al !mpla&t :*orpla&t;< si1 small
capsules i&serted by a health care
professio&al u&der the s'i& of upper arm
that deliver small amou&ts of hormo&e to
preve&t ovaries from releasi&" e""9 typical
use effective&ess< AAC
M +rotects a"ai&st
pre"&a&cy for up to five
years
M *o actio& reHuired prior
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
M Can be used )hile breast.
feedin* be*innin* si@
)ee8s after deli#erin*
baby
M *ot effective a"ai&st S0?
tra&smissio&
M +ossible scarri&" or, rarely,
i&fectio& at i&sertio& site
M Side effects i&clude irre"ular
bleedi&", headaches, &ausea,
depressio&
M *ot effective a"ai&st S0?
tra&smissio&M .ffective o&e to si1
years, depe&di&" o& type
used7ormo&al !&ectio& :?epo-
+rovera;< in?ection *i#en by a health
care professional in the arm or
buttoc8 e#ery 9A )ee8s to preve&t
ovaries from releasi&" a& e"" a&d/or
thic'e& cervical mucus to 'eep
sperm from reachi&" a& e""9 typical
use effective&ess< AAC
M (ay cause spotti&" betwee& periods a&d
lo&"er, heavier periods
M Increased ris8 of pel#ic inflammatory
disorder0PI,7 )ithin first four months
after insertion
M /are ris' of uteri&e perforatio&
M *o actio& reHuired prior to se1ual
i&tercourse, permits se1ual
spo&ta&eity
M +rotects a"ai&st
pre"&a&cy for 12 wee's
M *o actio& reHuired prior
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
M Can be used )hile breast.
feedin* be*innin* si@
)ee8s after deli#erin*
baby
M +rotects a"ai&st ca&cer of
the uteri&e li&i&" a&d iro&
deficie&cy a&emia
M *ot effective a"ai&st S0?
tra&smissio&
M Side effects i&clude irre"ular
bleedi&", wei"ht "ai&,
headaches, depressio&,
abdomi&al pai&
M Side effects do &ot reverse
u&til medicatio& wears off
M (ay cause delay i& becomi&"
pre"&a&t after i&ectio&s are
stopped
M *ot effective a"ai&st S0?
tra&smissio&*atural 8amily +la&&i&"<
tech&iHues, i&cludi&" chec'i&" body
M +erma&e&t protectio&
from pre"&a&cy
M *o actio& reHuired prior
M *ot effective a"ai&st S0?
tra&smissio&
M /eactio&s to sur"ery may
24
temperature or cervical mucus daily or
recordi&" me&strual cycles o& a cale&dar, to
determi&e the days whe& body is most
fertile9 typical use effective&ess< =1CM *o
medical or hormo&al side effectsM *ot
effective a"ai&st S0? tra&smissio&M
+erma&e&t protectio& from pre"&a&cy0ubal
5i"atio&< sur"ical procedure to perma&e&tly
bloc' woma&Is 8allopia& tubes to preve&t
e""s from reachi&" sperm9 typical use
effective&ess< AAC!&trauteri&e ?evice
:!,?;< small device i&serted by a health
care professio&al i&to the uterus9 preve&ts
e""s from bei&" fertili2ed a&d/or impla&ti&"
i& uterus9 typical use effective&ess< A6C
M /eHuires strict record'eepi&"
M !ll&ess or lac' of sleep may affect body
temperature
M @a"i&al i&fectio&s a&d douches may affect
cervical mucus
M /eHuires absti&e&ce from se1ual
i&tercourse or alter&ative co&traceptio&
duri&" fertile days
M !&e1pe&sive
M 6ccepted by most reli"io&s
M /eactio&s to sur"ery may i&clude
i&fectio&, blood clot &ear testes,
bruisi&", swelli&", or te&der&ess of
scrotum
M !rreversible
M *o actio& reHuired prior to se1ual
i&tercourse, permits se1ual spo&ta&eity
"ubal li*ation1 isthmus part in the
fallopian tube is the usual part bein*
li*hted#
Intra.uterine ,e#ices 0IU,;- a
small plastic obect is i&serted i&to the
uterus where it remai&s i& place# !t
i&terferes with the ability of the ovum to
develop as it tra&sverses the fallopia&
tube#
Most %re4uent Side $ffect<
a# $@cessi#e Menstrual flo)
0menorrha*ia7 b. Spontaneous
$@pulsion of the de#ice1 Myometrium
irritability c. Crampin* < fe#er
Contraindications1
1# +istory of PI,1 a )oman usin* IU,
has FCB chance of *ettin* PI,.
A. $ctopic Pre*nancy3 AI,S
Ne#er use > *i#e IU, to NULLIPAOUS
to se1ual i&tercourse,
permits se1ual
spo&ta&eity
i&clude i&fectio&, bleedi&",
i&ury to i&testi&e, reactio& to
a&esthesia
M !&creased cha&ce of ectopic
pre"&a&cy
M !rreversible
25
6OM$NDDD
eturn to the clinic for e#aluation after
her 9
st
mensesDDD
8i"ure !&tra uteri&e device
:!,?;
@asectomy< sur"ical procedure to perma&e&tly bloc' the maleIs vas defere&s to preve&t sperm
from reachi&" e""s9 typical use effective&ess< AAC
Section II
Ante&a'tu "e'io(
I. Assessent of Ris2 *acto's in t#e "'enatal "e'io(
Age o% Pregnant 1o+en 91$ below< 7ave a hi"her i&cide&ce of
1# +rematurity
2# +re"&a&cy !&duced 7yperte&sio&
3# 3ephalopelvic ?isproportio&
1o+en over 23 /ears old are at is4 %or"
1# 3hromosomal ?isorders i& i&fa&ts
2# +!7
3# 3esarea& ?elivery
"'ii$'a)i(a 9 1st time +re"&a&cy
"'ii&a'a 9 1
st
delivery of a live i&fa&t,
Nulli$'a)i(a 9 &ever bee& pre"&a&t
)n%ections" !se .&#*
T - 0o1oplasmosis
O - )ther i&fectio&s
R - /ubella
C - 3ytome"alovirus
H - 7erpes
6# 0o1oplasmosis :proto2oa;
+roduces symptoms of acute, flu-li'e i&fectio& i& mother
0ra&smitted throu"h raw meat or ha&dli&" cat litter of i&fected cats
S&ontaneous abo'tion li2el! to occu' ea'l! in &'e$nanc!
-# /ubella
E$tre+el/ teratogenic in %irst tri+ester
#auses congenital de%ects o% e/es5 heart5 ears5 and 0rain
26
1o+en 6ith lo6 ru0ella titers should 0e vaccinated at least 2 +onths 0e%ore 0eco+ing ,regnant or %ollo6ing
a deliver/
N&.E" Any )oman in the first trimester of pre*nancy is at ris8 if e@posed to rubella. Con*enital %etal defects
often results from such an infection.
3# 3ytome"alovirus :3(@;
#+roduces flu-li'e or mo&o&ucleosis-li'e symptoms i& the mother
0ra&smitted throu"h the respiratory or se1ual route
(ay cause fetal death, retardatio&, heart defects, deaf&ess
*o effective treatme&t available
?# 7erpes Simples
6ffects the e1ter&al "e&italia, va"i&a, a&d cervi1
3auses drai&i&", ,ain%ul vesicles
?elivery of the fetus is usually by cesarea& sectio& active lesio&s are prese&t i& the va"i&a9 delivery may be
performed va"i&ally if the lesio&s are i& the a&al, peri&eal, or i&&er thi"h area :strict precautio&s are
&ecessary to protect the fetus duri&" delivery;
*o va"i&al e1ami&atio&s are do&e i& the prese&ce of active va"i&al herpetic lesio&s
7aintain #&N.A#. isolation ,rocedures during hos,itali8ation i% the disease is active
*eo&ate a&d mother may be se&a'ate( (u'in$ t#e acti)e &e'io(, or other special precautio&ary measures
may be used to avoid tra&smissio& to &eo&ate
.eratogenic Drugs" BASA-&(code9
1 9 -arbiturates
A 9 6&ti-malarial
S 9 Salicylates
A 9 6&esthetic
O 9 Oral hypo"lycemics
Su0stance A0useA
Alcohol" causes lear&i&" disabilities, (o&"olism, fetal alcohol sy&drome
NicotineA i&creases vasoco&strictio&, retardatio&, S46 :small "estatio&al a"e;, low birth wei"ht
*eroin addictA babies are bor& with an $'A--$A"$,> +5P$AC"I&$ CNS > $%L$'$S or
CNS II"A(ILI"5.
#occaine" "he effect of cocaine in a labor and the fetus is preterm labor thus increased uterine
contractions3 intrauterine *ro)th retardation and the potential for a sic83 addicted infant
II. "#!siolo$ical #hanges in Pregnanc/
Inc'eases (u'in$ &'e$nanc!
!&crease 7eart /ate for 1B-15 beats/mi&ute
!&crease 3ardiac )utput for 2BC - 3BC duri&" 1
st
> 2
&d
trimester to meet i&crease tissue
dema&d
!&crease secretio& of su"ar :4lycosuria;
INC$AS$ PLAMA &OLUM$
!&crease ,ri&ary 8reHue&cy due to pressure to bladder#
2$
!&crease &ormal depe&de&t .dema :bilateral or a&'le edema; &ormal for 36 wee's "estatio&#
Dec'eases (u'in$ &'e$nanc!
?ecrease :sli"htly of blood pressure; i& the 2
&d
trimester due to decrease peripheral resista&ce
?ecrease 7emo"lobi& & 7ematocrit because of !ro& ?eficie&cy 0Pseudo. AN$MIA;
?ecrease "astroi&testi&al motility & peristalsis due to displaceme&t of the i&testi&e & compressio&
of the stomach# ---leadi&" to 3)*S0!+60!)*#
?ecrease ,ri&e Specific "ravity< a result of i&crease ,ri&ary )utput#
Ot#e'sA
#hloas+a " Mas8 of pre*nancy
Leu4orrhea" )hitish #a*inal dischar*e )ithout si*ns of inflammation < itchin*.
&,erculu+" formation of mucus plu* in C$&I' to seal out bacteria.
Lordosis" the Pride of Pre*nancy
ela$in" responsible hormone for the softenin* of the pel#ic cartila*es. Produce by the corpus luteum3
contributes to the )addlin* *ait typically noted in pre*nancy.
Nor+al deliver/ 0lood loss" ECC I JCC ml of blood
#esarean Section" ;CC I 9CCC ml
II a. Ante&a'tu Healt# "'ootion
"'enatal ;isit
Sc#e(ule of )isit if <it# no co&licationsA
a. E)e'! . <ee2sD u& to 3- <ee2s
b. E)e'! - <ee2sD f'o 3-934 <ee2s :o'e f'eFuentl! if &'obles e,ist+
c. E)e'! <ee2 f'o 349.8 <ee2s
Classifications of "'e$nanc!
GRA;IDA > &umber of times pre"&a&t, re"ardless of duratio&, i&cludi&" prese&t pre"&a&cy#
"RIMIGRA;IDA > pre"&a&t for the first time#
ItGs important for the nurse to distin*uish bet)een a client )hoGs ha#in* her first baby and one )ho has already
had a baby. %or the client )hoGs pre*nant for the first time3 4uic8enin* occurs around AC to AA )ee8s. 6omen
)ho ha#e had children )ill feel 4uic8enin* earlier3 usually around 9; to AC )ee8s3 because they reco*ni2e the
sensations.
MULTIGRA;IDA > pre"&a&t for seco&d or subseHue&t time#
"ARA > &umber of pre"&a&cies that lasted more tha& 2B wee's#
NULLI"ARA > a woma& who has &ot "ive& birth to a baby beyo&d 2B wee's "estatio&#
"RIMI"ARA > a woma& who has "ive& birth to o&e baby more tha& 2B wee's "estatio&#
MULTI"ARA > a woma& who has had two or more births at more tha& 2B wee's "estatio&#
Note1 ")ins or triplets counted as 9 para#
PE.E7 I ne)born born before EK )ee8s of *estation.
TERM > &ewbor& bor& after 3$ wee's to 4B wee's of "estatio&#
"OST9TERM > &ewbor& bor& after 4B wee's of "estatio&#
"a'it! :T"AL+
T 9 *umber of terms births,
" 9 *umber of premature births,
A 9 *umber of 6bortio&s,
2=
L 9 *umber of livi&" childre&
NUTRITION
1
st
.ri+ester" A IJ lbs *ain > EC.EF calories>8*>day
2
nd
tri+ester" 9 lb per )ee8 > ACC calories>8*>day
2
rd
tri+ester" 9 lb per )ee8> ACC calories>8*>day
"'e$nant ?oen nee(s 2:: e$tra calories PE DA; fo' a(eFuate nut'ition.
A (iet of 23:: calories ,er da/
An inc'ease of about 3:: calories ,er da/ is nee(e( (u'in$ LA#.A.)&N.
)ron De%icienc/ Ane+ia is a 'esult of P)#A.
Diffe'ent t!&es of E,e'cises
Pelvic (loor #ontractions (Kegel<s E$ercise+A +romotes peri&eal heali&", i&crease se1ual
respo&sive&ess, press stress i&co&ti&e&ce# ?o&e 5B-1BB times# .1amples< 0i"hte&i&" &
stre&"the&i&" the muscles of the @a"i&a, rectum, peri&eum & the& rela1 after# .fficie&t for
,ri&ary 8reHue&cy & 7emorrhoids# !&crease elasticity of the Pubococcy*eus muscle#
A0do+inal +uscle #ontractionsA pre#ent constipation i& pre"&a&cy, do&e i& sta&di&" or lyi&" positio&,
stre&"the&i&" the abdomi&al muscles#
Pelvic oc4ingA elie#es bac8ache duri&" pre"&a&cy, do&e by ti"hte&i&" the buttoc's & flatte&s the
lower bac' a"ai&st the floor for o&e mi&ute#
DI**ERENT T="ES O* 1REATHING TECHNIGUES
6# 6bdomi&al breathi&" : duri&" late&t phase of Sta"e 1 5abor;
1# ,sed u&til labor is more adva&ced
2# 0he abdome& moves outward duri&" i&halatio& a&d dow&ward duri&" e1halatio&
3# 0he rate remai&s slow, with appro1imately si1 to &i&e breaths per mi&ute
-# +a&t-pa&t-blow: duri&" 0ra&sitio&al +hase of Sta"e 1 5abor;
1# ,sed i& adva&ced labor
2# 6 more rapid patter&, co&sisti&" of two short blows from the mouth followed by a lo&"er blow
3# 6ll e1halatio&s are a blowi&" motio&
III. *e'tili3ation to Conce&tion
*e'tili3ationA the u&io& of the ovum & sperm# 0he start of (itotic cell divisio& < fetal se@
determination.
N +rimary oocyte :immature ovum; co&tai&s ?iploid &umber of chromosomes :46;#
N )&e oocyte co&tai&s a haploid :23; &umber of chromosomes after divisio&#
N 4amete :mature ovum;< is a cell or ovum that has u&der"o&e (aturatio& & will be ready for
fertili2atio&#
N )&e "amete carries 23 chromosomes#
N 6 sperm carries 2 types of se1 chromosomes# O & F#
N 4BB millio& sperm cells i& o&e eaculatio&#
N 8u&ctio&al 5ife of spermato2oa is 4= hours
N OOJ female, OFJ male#
2A
*i$u'e %9* Mo'ula
"'ocess of *e'tili3ationA
6fter ovulatio& ovum will be e1pelled from the 4raafia& follicles ovum will be surrou&ded by Lona
Pellucida :mucopolysaccharide fluid; & a circle of cells 0Corona adiata; which i&creases the bul' of the
)vum e1pelled from the 8allopia& 0ube by the 8imbriae :i&fu&dibulum;# Sperms move by fla"ella &
+e&etrate the & dissolve the cell wall of the ovum by releasi&" a proteolytic e&2yme
:+yaluronidase7 6fter pe&etratio& 8usio& will result to Ly*ote# Gy"ote mi"rate for 4 days i& the
body of the uterus :(itosis will ta'e place-3leava"e formatio& will be"i&; 6fter 16-5B cell formatio& from
mitosis, a mulberry & -umpy appeara&ce will follow morula 0%igure 1-(7 ---after 3-4 days, the structure will
be ball li'e i& appeara&ce which will be called (lastocyst# 3ells i& the outer ri&" are called "rophoblast :later it
forms the place&ta, respo&sible for the devEt of place&ta & fetal membra&e9 3ells i& the i&&er ri&" are called
$rythroblas t cells :which will be the embryo;#
Te's to 'eebe'A
&vu+A 8rom ovulatio& to fertili2atio&
=/goteA 8rom fertili2atio& to impla&tatio&
E+0r/oA 8rom impla&tatio& to 5-= wee's#
(etus" 8rom 5-= wee's u&til term
"he o#um is said to be #iable for AJ.36 hours#
Sodium (icarbonate. the freHue&t medicatio& to alter the va"i&al ph, decrease the acidity of the
va"i&a so as to !*3/.6S. 07. ()0!5!0F )8 07. S+./(#
*i$u'e %9G *etal Meb'anes
*etal Meb'anes< membra&es that surrou&d the fetus, & "ive the place&ta the shi&y appeara&ce#
:*i$u'e %-4;
2 5ayers<
a. A+nion< shi&y membra&e o& the 2
&d
wee' of .mbryo&ic ?evelopme&t & e&closes the 6m&iotic
3avity
b. #horion1 )uter membra&e that supports the sac of the am&iotic fluid#
#horionic Villi1 fin*er li8e pro?ections from the chorion. "his is the place )here *ases3 nutrients and
)aste products bet)een the maternal < fetal blood ta8es place.
Aniotic *lui(< surrou&ds the embryo, co&tai&s fetal uri&e, la&u"o from fetal s'i& & epithelial cells#
+h is $# 2# Specific 4ravity< 1#BB5 > 1#B25
Normal Amount1 FCC I 9CCC ml.
Oli*ohydramnios. less than ECC ml.
Polyhydramnios. more than ACCC ml. obser#e for ,o)n syndrome < con*enital defects
8u&ctio&s of 6m&iotic 8luid<
a# +rotects the fetus from cha&"es i& the temperature & cushio& a"ai&st i&ury#
b# +rotects the umbilical cord from pressure, the fetus dri&'s & breaths the fluid
i&to the lu&"s#
Aniotic *lui( Colo's< *ormal color< tra&spare&t, clear, with white ti&y spec's
,ar8 amber or yello)< )mi&ous si"& of prese&ce of -ilirubi&, hemolytic disease
Port 6ine Colored< 6bruptio +lace&ta
-reenish1 (eco&ium Stai&ed / 8.065 ?!S0/.SS< always "o for Cesarian SectionP 6lso if ph is
less than K.A
If )ith odor< deliver withi& 24 hours, may i&dicate i&fectio&#
3B
Ubilical Co'(A 21 i&ches i& le&"th & 2 cm i& thic' &ess, circulatory commu&icatio& of the fetus to the
mother# 3)*06!*S 2 6/0./!.S & 1 @.!*# 3overed by a "elati&ous mucopolysaccharide called
6hartons ?elly.
!mpla&tatio& occurs at the e&d of the 1st wee' after fertili2atio&, whe& the blastocyst attaches to the
e&dometrium# ?uri&" the 2&d wee' :14 days after impla&tatio&;, impla&tatio& pro"resses a&d two "erm layers,
cavities, a&d cell layers develop# ?uri&" the 3rd wee' of developme&t :21 days after impla&tatio&;, the
embryo&ic dis' evolves i&to three layers, a&d three &ew structures Q the primitive strea', &otochord, a&d
alla&tois Q form# .arly duri&" the 4th wee' :2= days after impla&tatio&;, cellular differe&tiatio& a&d
or"a&i2atio& occur#
*i$u'e %9H *e'tili3ation C!cle
0able Summary from 8ertili2atio& to !mpla&tatio& :8i"ure 1-7;
III.a ORIGIN O* 1OD= TISSUE
.issue La/er Bod/ Portion (or+ed
.30)?./( *ervous system, mucus membra&es, a&us & mouth
(esoderm 3o&&ective 0issue, /eproductive, circulatory & upper
,ri&ary system, bo&es, cartilla"e
.&doderm li&i&" of the 4! tract, /espiratory 0ract, bladder & urethra
MULTI"LE "REGNANCIES
Dou0le ovu+ Single &vu+
?i2y"otic/frater&al twi&s (o&o2y"otic/ide&tical twi&s
)va from same or differe&t ovaries u&io& of a si&"le ovum & a si&"le sperm
Same or differe&t se1 same se1 o&e place&ta
2 place&tas but maybe fused
2 chorio&s & 2 am&io&s o&e chorio& & 2 am&io&s
Genetics"
"#enot!&eA !&dividualEs outward appeara&ce
Genot!&e< !&dividuals 4e&etic (a'e up
Ha'!ot!&eA +ictorial a&alysis of i&dividualEs chromosomes
Se'ot!&eA a&ti"e&ic character R6-)S
31
+/.-8./0!5!G60!)*
630!@!0!.S
)vum moves to amulla of
fallopia& tubes
3apacitatio&
6crosome reactio&
3)*3.+0!)*
Go&a reactio&
Gy"ote :fertili2ed ovum9
about 24-4= hrs, divides9
cleava"e divides, travels to
the uterus
!(+56*060!)*
(orula :after 3-4
days impla&tatio&;
-lastocyst
:trophoblast9
embryolast;
!mpla&ts complete
w/& $-1B days
Genetic Disorders"
Autoso+al ecessive DisordersA both me& & wome& are at eHual ris' because the ?.8.30!@. 4.*.
is a& 6,0)S)(.< o&e of 22 pairs of &o&-se1 chromosomes# )ffspri&" of each pre"&a&cy
has a 25C cha&ce of bei&" affected a&d 5BC cha&ce of bei&" a carrier#
E$a+,les are" P=U 0 phenyl8etenuria7 3 "ay . Sachs ,isease3 Cystic %ibrosis3 "hallasemia3
and Sic8le Cell Anemia
Autoso+al Do+inantA a& affected offspri&" has a& affected pare&t#
E$a+,les are" +untinton/s Chorea and Marfan/s Syndrome 0Arachnodactyly7
>-lin4ed do+inant?ecessive Diso'(e's< ab&ormal "e&e is fou&d o& the O chromosome because me&
have o&ly o&e O chromosome, they always e1press the disorder#
E$a+,les are1 +emophillia and ,uchenne Muscular ,ystrophy
I;. *ETAL DE;ELO"MENT
*i$u'e %9 H- *etal De)elo&ent
+lace&
tal
tra&sp
ort of
substa
&ces
: 5
wee's
;
0he
fetus is 2$-31 mm
a&d wei"hs 2-4
"rams
8etus s
mar'edly be&t
7ead
is
disproportio&ately
lar"e due to brai&
developme&t
3e&ter
s of bo&e be"i& to
ossify
4a&"li
o&ic cells :5
th
to
12
th
wee's;
+lace&ta a&d meco&ium
.mbryo is 4-5 mm le&"th
0rophoblasts embedded i& deciduas
8ou&datio&s for &ervous system, "e&itouri&ary system, s'i&, bo&es, a&d
lu&"s are formed
/udime&ts of eyes, ears, &ose appear
Cardio#ascular system functionin*3 heart be*innin* to beat3 be*innin* of heart circulation.
Placenta de#/t.
32
are prese&t, with facial features
1 mo/ 4 wee's
3 mos#/A-12 w's
2 mo/ 5-= wee's
C&S done 0; 9A )ee8s7 e#ery or*an present3 +ead *reatly enlar*ed
6vera"e le&"th is 5B-55 mm a&d wei"hs 45 "ms#
8i&"ers a&d toes are disti&ct#
+lace&ta is complete#
/udime&tary 'id&eys secrete uri&e#
8etal circulatio& is complete#
.1ter&al "e&italia show defi&ite characteristics#
4a&"lio&ic cells
S$' IS &ISUALL5 $CO-NILA(L$# +eart is audible in a ,oppler 0 99
th
)ee87
8etus swallows# %ith &ails# Lid&eys able to secrete#
4 mos# /13-16 wee's A4-14B mm le&"th a&d wei"hs A$-2BB "ms#
7ead is erected, lower limbs are well developed#
7eartbeat is prese&t
*asal septum a&d palate close
8i&"erpri&ts are set
LANU-O APP$AS IN "+$ (O,5
=
mos# /
3B-34
wee's
5e&"t
h
2=B-
32B
mm#
wei"h
t
1$BB-
25BB
"ms#$
mos# /
26-2A
wee's
5e&"t
h
25B-
2$59
wei"h
t A1B-
15BB
"ms#2
8etus is 15B-1AB mm# !& le&"th a&d wei"hs appro1imately 26B-46B
"ms#
5a&u"o covers e&tire body#
.yebrows a&d scalp hair is prese&t#
+eart sounds are perceptible by auscultation.
&erni@ caseosa co#ers s8in#
+eartbeat can be heard in the fetoscope 0 9; )ee8sMAC )ee8s7. Li#er is already pancreas
functionin*.
Quic8enin* felt by a mother. S8eleton be*ins to de#elop.
(ro)n %ats be*in to form. +eart sounds in the stethoscope
Can be heard 0 9K. AC )ee8s7
NO"$1 .here is a ,lacental 0arrier to s/,hilis until the 1@
th
6ee4 o% ,regnanc/.
)% the +other is treated 0e%ore 1@
th
6ee45 the 0a0/ 6ill +ost li4el/ not 0e
a%%ected.
33
1-25
%..
LST
)5?
(6*
Es
863.
5
mos# /
1$-2B
wee's
0oe&ails become
visible
Steady wei"ht
"ai& occurs
@i"orous fetal
moveme&t occurs#
LANU-O ,ISAPP$AS
are fully de#eloped.
A)are
of
sounds
outside
the
body.
Assum
es the
deli#er
y
positio
n.
Increa
sed
chance
of
sur#i#
al.
S'i& red
/hythmic
breathi&" occurs
+upillary
membra&e
disappears from
eyes#
8etus ofte&
survives if bor&
prematurely
(rain de#elops
rapidly. Lecithin. Sphin*omyelin 0L>S
ratio is already A197
(rains fully de#eloped. If born3
34
neonate may sur#i#e.
5e&"th 2BB-24B
mm# %t# 4A5-A1B
"ms#
S'i& appears
wri&'led a&d pi&'
to red#
/.( be"i&s
.yebrows a&d
fi&"er&ails
develop#
&$NI' CO&$S "+$ $N"I$
(O,5. +as the ability to hear.
Production of lun* surfactants.
Passi#e Antibody transfer
0 placental immuno*lobulin -7
Su
stained
)ei*ht
*ain
occurs.
A mos# /35-3$ wee's6
mos# /21-25 wee's
5e&"th 33B-36B mm# wei"ht 2$BB-34BB "ms#
8ace a&d body has a loose wri&'led appeara&ce because of
subcuta&eous fat deposit#
-ody is usually lump a&d la&u"o disappears
*ails reach fi&"ertip ed"e
6m&iotic fluid decreases#
Increase ,e#elopment. Sole of the foot ha#e already
creases. -ood chance of sur#i#al.
.
a
r
l
i
e
s
t
t
e
s
t
p
o
s
s
i
b
l
e
o
1B mos# / 3=-4B wee's 5e&"th 36B mm#9 %ei"ht 34BB-36BB
"ms#
S'i& is smooth, chest is promi&e&t
.yes are u&iformly slate colored
-o&es of s'ull are ossified a&d are
&early to"ether at sutures#
"estes are in scrotum.
Optimum "ime for sur#i#al.
%ull term. Li*htenin* is present.
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"he dia*nosis of iron.deficiency
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patient/s nausea.
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#
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T#i'(Alte'nate feelin$s of
eotional <ell9bein$
an( liabilit!.
6ccepta&ce of pre"&a&cy#
+ossible i&crease i& se1#
6dustme&t to cha&"e i& body
ima"e#
8eeli&"s of aw'ward&ess a&d
clumsi&ess#
/e&ewed fears a&d te&sio&s
about labor#
Spurt of e&er"y duri&" last
mo&th#
.
+repari&" for pare&thood#
JI AM A MOTHERK
,urin* the third trimester3 a 8ey
psychosocial tas8 is to o#ercome fears
the )oman may ha#e about the
un8no)n3 labor pain3 loss of self.
esteem3 loss of control3 and death.
"he emotions and fears that are
usually felt durin* the third trimester
are feelin*s of Nu*linessO3 alterations
in body self.ima*e and an@iety about
the comin* labor and deli#ery.
A. MATERNAL ADA"TATIONS DURING "REGNANC= / <it# 1IOLOGICAL TASHS O*
"REGNANC=
*i'st T'ieste'A 6(-!@65.*3.- about pre"&a&cy< pre"&a&t woma& focus o&ly to self#
I am pre*nant. QAccept the biolo*ical fact of pre*nancy
Secon( T'ieste'A 633.+06*3.---of the ide&tificatio& of motherhood & aware&ess & i&terest i& the fetus#
I am *oin* to ha#e a babyQ Accept the *ro)in* fetus as distinct from self < as person to care for
T#i'( T'ieste'A .()0!)*65 56-!5!0F- assumi&" already the mother, fears & fa&tasies & dreams about
labor
I am *oin* to be a motherQPrepare realistically for birth < parentin*
1. "ATERNAL ADA"ATATIONS / REACTIONS TO "REGNANC=
#&!VADE S;ND&7E1 identification of the motherH ambi#alence < an@iety about the role chan*e
EEAL&!S; S.AGE" increase interest in mothers care.
SEL(-#&N#EP. #*ANGE" acti#e in#ol#ement in the fears < death of the fetus.
SECTION III
6*0.+6/065 3)(+5!360!)*S
A. Abo'tion
-termination of pre*nancy before the fetus is #iable (2: 6ee4s or a 6eight o% 3:: *7
15A
6-)/0!)*
0herapeutic Spo&ta&eous
!&evitable 0hreate&ed
*i$. ... 0yp e s o f 6b o r t i o &
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ss is
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cervi
cal
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o&Sa
ve
tissue
fra"
me&t
s3#
3om
plete
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ucts
of
co&ce
ptio&
are
totall
y
e1pel
led(
i&ima
0he
co&ti&uatio&
of the
pre"&a&cy is
i& doubt
-leedi&"
or
spotti&"
closed
cervi1
-edrest, /estrictive
activity, Sedatio&, 6void
coitus for 2 wee's
followi&" last evide&ce
of bleedi&"
ho*am indicated )hen
a youn* patient has a
threatened abortion in
the first trimester and a
laboratory studies
re#eal an h ne*ati#e
and the husband is h
positi#e
16B
3omplete !&complete (issed 7abitual
l
bleed
i&"3
o&ti&
uous
mo&it
ori&"
1#
0hrea
te&ed
/ete&
tio&
of the
produ
cts of
co&ce
ptio&
after
fetal
death
!&ter
mitte
&t
bleed
i&"9
abse&
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uteri&
e
"rowt
h.va
cuati
o&, ?
&
34#
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e2#
!&evit
able
Some
fra"me&ts
are retai&ed
i&side the
uteri&e
cavity
+rofuse
bleedi&"
?ilatatio& & 3uretta"e9
,se of o1ytoci&<
O@ytocin nasal spray
should be administered
)hile the client is
sittin* )ith her head in
a #ertical position. A
nasal preparation must
not be administered
)ith the client lyin*
do)n or the head tilted
bac8 because this could
cause aspiration.
.vacuatio&
S
i
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&
s
a
6#7abitual / /ecurre&t
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-.&dometriosis
-Smo'i&"
.+istory of IU,
usa*e
.
-@a"i&al -leedi&"
-=nife.li8e abdominal pain
-eferred pain on the ri*ht
shoulder
-Symptoms of Shoc8< decreased -+
i&creased //, fast but thready
pulse# "his is the number 9
complication.
-+elvic pressure of pelvic full&ess
-3ulle&Es si"&
-Pain unilaterally3 )ith crampin*
and tenderness
. Mass in the adne@al or cul.de.
sac
- Sli"ht, dar' va"i&al bleedi&"
- +rofou&d shoc' if rupture occurs
-3uldoce&tesis
-3uldoscopy
-/adioimmu&oassay of
elevated serum Hualitative
--eta-734
-6bdomi&al ,ltrasou&d
--lood samples of 7"b
a&d 7ct9 blood type a&d
"roup
(o&itor amou&t of
bleedi&"
6ssess vital si"&s
6ssess abdomi&al pai&
-lood tra&sfusio&
Sur"ery< Salpi&"ostomy
6dmi&ister /ho"am for
/h :-; clie&t
.he F1 #o+,lication o% Ecto,ic Pregnanc/ is *e+orrhagic Shoc4.
1$5
C. H!(ati(ifo' ole / T'o&#oblastic Disease / Mola' Disease
- 4estatio&al trophoblastic &eoplasm that arise from the chorio&9 characteri2ed
by the proliferatio& a&d de"e&eratio& of the chorio&ic or trophoblastic villi#
A patient )ith +ydatidiform mole has a positi#e si*ns of pre*nancy but is not pre*nant.
"he R9 Complication is #horiocarcino+a
"he "hree + of +.mole
9.*yper . emesis *ra#idarum
A. increase *c*
E. increase incidence for pi*
+/.?!S+)S!*4
8630)/S
0F+.S (6*!8.S060!)*S ?!64*)S0!3
0.S0S
(6*64.(.*0
1# INCOMP$"$N"
C$&I'S/non/+sD/s%unctional
cervi$Predis,osing?#ontri0uting
(actors"e,eated dilatation o% the cervi$5
+aternal DES ( Dieth/lstil0estrol9
E$,osure5 .rau+atic inGuries to the
cervi$. #ongenital ano+al/.he F1
#o+,lication o% *-+ole is
choriocarcino+a7olar evacuation ?
DA#Lo6 socioecono+ic status
2# 0rauma to the cervi1 :sur"ery / birth;
3# ,teri&e a&omaly
4# 7abitual abortio&
5# +re-term labor
1.
ii. D. Inco&etent ce')i,
- +ai&less premature dilatatio& of the cervi1
:usually i& the 9:
th
to AC
th
)ee87
1# 3omplete/ classical parts of the villi are affected
2# !&complete/ partial- some parts are &ormal
1# @a"i&al bleedi&"
2# .1cessive */@
E. apid enlar*ement of the uterus
J. 0P7 Pre*nancy test
5# +ossible +!7
6# 6bdomi&al cramps
$# 6bse&t 87/
=# .levated 734 titer< 1-2 millio& !,9 *ormal level< 4BB,BBB !,
1$6
INCOM"ETENT CER;I@
8i"ure 1A
2. 3hemotherapy
B. (o&itor 734 levels
3. ?elay childbeari&" pla&s for a year
H. +eri&eal pad cou&ts
I. !&struct the couple to have @64!*65 /.S0
: &o se1; for 1 year#
1# %ome& below 1= or above 35
2# !&ta'e of 3lomid :3lomiphe&e 3itrate;
3# %ome& of asia& herita"e
!&itial Si"&s734 titer determi&atio&
9. Ultrasound
2# O-ray of the abdome&
:. Sho) 0a pin8.stained #a*inal dischar*e7
$# F1 Sign1 upture of membranes and dischar*e
of amniotic fluid
1# 0he cervi1 dilates pai&lessly i& the
seco&d trimester of pre"&a&cy#
-loody show5ate si"&s<
2#+/)(
3#+ai&less dilatatio&
=# -irth of dead/&o&-viable fetus
A# +ressure or heavi&ess o& the lower abdome&#
1B# ,ltraso&o"raphy-est maor sur"ery<3ervical
3ercla"e, (c?o&ald 3ercla"eScree&i&" or
i&itial dia"&ostic
test<3ardi&al/+atho"&omo&ic/maor si"&<
11# ,ltrasou&d
+ossible sur"ical complicatio&<3o&formity test< 12# Sterility, rupture of the cervi1 premature
delivery, pelvic bleedi&" a&d i&fectio&#
Side lyi&" positio&?isease
complicatio&
+ro&e positio&
13# X9 +emorrha*e, .ctopic pre"&a&cy, birth
defects, viruses a&d pre"&a&cy diseases,
diabetes i& pre"&a&cy, 7+*
14# 4.S060!)*65 ?!6-.0.SDefinitionA t/,e
o% Dia0etes 6here onl/ ,regnant 6o+en gets
6here her 0lood sugar rate elevates 0ut never
had a high 0lood sugar rate 0e%ore
,regnanc/.S!non!sDiabetes (u'in$
"'e$nanc! *ursi&" ?ia"&osis3ervical
!&compete&ce*ursi&" !&terve&tio& Pre.
op1 $ncoura*e patient to maintain bed
rest(est side e4uipment(est position
before and after sur*ery
(Pillitteri5 7aternal and #hild Nursing5
,.2J1-J29
E. DIA1ETES MELLITUS
Suctio&
1$$
4estatio&al diabetes mellitus :pre"&a&cy
i&duced;
A pre*nant3 insulin.dependent diabetic is at
ris8 for sudden h/,ogl/ce+ia because insulin
needs and metabolism are affected b pre*nancy3
ma8in* sudden hypo*lycemic episodes more
common for diabetics.
3ha&"es i& the "lucose-i&suli& mecha&ism<
o .arly i& pre"&a&cy<
6# !&crease productio& of
i&suli&
-# (ater&al "lucose is
co&sumed by fetus
o 5ate i& pre"&a&cy<
6# (other develops
i&suli& resista&ce
-# 0he prese&ce of
place&tal i&suli&ase
brea's dow& i&suli&
rapidly
-# ?escriptio& of
?iabetes i& +re"&a&cy
*
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+563.*06
+/.@!6Nu'sin$
Consi(e'ationsA
. 3lie&t is hospitali2ed a&d
put o& bed rest
# 3o&ti&ually mo&itor fetal
well- bei&"
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i&dicate
# (easure blood loss
throu"h peri&eal pad cou&ts
# *) va"i&al e1ams
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Nu'sin$ Consi(e'ationsA
# -ed rest i& wed"e positio& too preve&t supi&e hypote&sio&
.
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?efi&itio&
"LACENTA "RE;IA
8i"ure 2B a
N !mproperly impla&ted place&ta i& the lower uteri&e se"me&t &ear or over
the i&ter&al cervical os
N 0otal< the i&ter&al os is e&tirely covered by the place&ta whe& cervi1 is fully
dilated
N (ar"i&al< o&ly a& ed"e of the place&ta e1te&ds to the i&ter&al os
N 5ow-lyi&" place&ta< impla&ted i& the lower uteri&e se"me&t but does &ot
reach the os :Sau&ders pa"e 2AA;
+redisposi&" 8actor N (ater&al a"e
N +arity :&o# )f pre"&a&cy;
N +revious uteri&e sur"ery
3ardi&al (a&ifestatio& N +ai&less bleedi&" as early as $ mo&ths :mild to hemorrha"e;
N Soft uterus
N 6bdomi&al fetal positio& of breech or tra&sverse lie
N ,teri&e co&tractio&s
N 6&emic
3omplicatio& N a&emia, X1hemorrha*e, X2shoc8, re&al failure, X3 disseminated
intra#ascular coa*ulation, cerebral ischemia, mater&al a&d fetal death
:*ursi&" 6lert p#41=;
2=1
0herapeutic !&terve&tio&s N ,ltraso&o"raphy to co&firm the pressure of place&ta previa#
N ?epe&ds o& locatio& of place&ta, amou&t of bleedi&" a&d status of the
fetus#
N 7ome mo&itori&" with repeated ultrasou&ds may be possible with type !-
low lyi&"
N 3o&trol bleedi&"
N /eplace blood loss if e1cessive
N 3esarea& birth if &ecessary
N -etamethaso&e is i&dicated to i&crease fetal lu&" maturity# :(osby,
3omprehe&sive p# 2B3;
*ursi&" ?ia"&osis with
*ursi&" !&terve&tio&
F1 N!S)NG D)AGN&S)S" Potential %luid volu+e de%icit
N (ai&tai& bed rest
N F1 Assess+ent - 7onitor +aternal vital signs5 (*5 and %etal activit/
N 6ssess bleedi&" :amou&t a&d Huality;
N (o&itor a&d treat si"&s of shoc'
N 6void va"i&al e1ami&atio& if bleedi&" is occurri&"
N +repare for premature birth or cesarea& sectio&
N 6dmi&ister !@ fluids as ordered
N 6dmi&ister iro& suppleme&ts or blood tra&sfusio& as ordered :mai&tai&
hematocrit level;
N +repare to admi&ister /h immu&e "lobuli&
-.S0+)S!0!)* .he ,atient 6ith ,lacenta ,revia should 0e +aintained on 0ed rest5
,re%era0l/ in a side-l/ing ,osition. Additional ,ressure %ro+ an u,right
,osition +a/ cause %urther tearing o% the ,lacenta %ro+ the uterine lining.
A+0ulating 6ould there%ore 0e indicated %or this ,atient. Per%or+ing a
vaginal e$a+ination and a,,l/ing internal scal, electrode could also cause
the ,lacenta to 0e %urther torn %ro+ the uterine lining.
2=2
A1RU"TIO "LACENTAEP Left late'al &osition
Confi'ato'! Test
A1RU"TIO "LACENTAE
8i"ure 21
N ,ltrasou&d for place&ta locali2atio&
*)0.<
Manual pel#ic e@aminations are contraindicated
)hen #a*inal bleedin* is apparent in the third
trimester unit a dia*nosis is made and placenta
pre#ia is ruled out. ,i*ital e@amination of the
cer#i@ can lead to maternal and fetal
hemorrha*e. A dia*nosis of placenta pre#ia is
made by ultrasound. "he hemo*lobin and
hematocrit le#els are monitored and e@ternal
electronic fetal heart rate monitorin* is initiated.
$lectronic fetal monitorin* 0e@ternal7 is crucial
in e#aluatin* the status of the fetus )ho is at ris8
for se#ere hypo@ia. 0Saunders Comprehensi#e
ACCA $dition3 p. ECJ7
-est +ositio&
?efi&itio& +remature separatio& of the place&ta from the uteri&e
wall after the 2B
th
wee' of "estatio& a&d before the fetus
is delivered :Sau&ders pa"e 2AA-3BB;
2=3
Pathophysiolo*y S Spontaneous rupture of blood #essels at the
placental bed may due to lac8 of resiliency or to
abnormal chan*es in uterine #asculature.
S May be complicated by hypertension or by an
enlar*ed uterus that can/t contract sufficiently to
seal off the torn #essels
S Conse4uently3 bleedin* continues unchec8ed3
possibly shearin* off the placenta partially or
completely. 0Nursin* Alert p.J7
(a&ifestatio& N +ai&ful va"i&al bleedi&"
N 7yperto&ic to teta&ic, e&lar"ed uterus
N Board-li4e rigidit/ o% a0do+en (#ullen Sign9
N 6b&ormal/abse&t fetal heart to&es
N +allor
N 3ool, moist s'i&
N -loody am&iotic fluid
N /isi&" fu&dal hei"ht from blood trapped behi&d the
place&ta
N Si"&s of shoc'
N (a&ifestatio& of coa"ulopathy
NO"$1
Uterine tenderness accompanies placental abruption3
especially )ith a central abruption and trapped blood
2=4
behind the placenta. "he abdomen )ill feel hard and
boardli8e upon palpation as the blood penetrates the
myometrium and causes uterine irritability.
Obser#ation of the fetal monitorin* often re#eals
increased uterine restin* tone3 caused by failure of the
uterus to rela@ in an attempt to constrict blood #essels
and control bleedin*. 0Saunders Comprehensi#e ACCA
$dition3 p. ECJ7
3omplicatio& S +emorrha*e3 shoc83 renal failure3 disseminated
intra#ascular coa*ulation3 maternal death3
fetal death0Nursin* Alert p.J7
"herapeutic Inter#entions N /eplaceme&t of blood loss#
N %ith moderate or severe separatio& or mater&al or
fetal distress< emer"e&cy childbirth#
*)0.<
.he goal o% +anage+ent in a0ru,tion
,lacentae is to control the he+orrhage and
deliver the %etus as soon as ,ossi0le. Deliver/
is the treat+ent o% choic i% the %etus is at ter+
gestation or i% the 0leeding is +oderate to
severe and +other or %etus is in Geo,ard/.
(Saunders #o+,rehensive 2::2 Edition5 ,.
2:B9
N %ith mild separatio& without fetal distress a&d i&
the prese&ce of some cervical effaceme&t a&d
dilatatio&< i&ductio& of labor may be attempted
N)1y"e& if &ecessary
N (ai&te&a&ce of fluid a&d electrolytes bala&ce#
:(osby, 3omprehe&sive p# 2B4;
*ursi&" ?ia"&osis with !&terve&tio& F1 N!S)NG D)AGN&S)S" is4 %or %luid volu+e
de%icit
T F1 Assess+ent" 7onitor and (*
N 6ssess for va"i&al bleedi&", abdomi&al pai&, a&d
i&crease i& fu&dal hei"ht
N (ai&tai& bed rest
N 6dmi&ister o1y"e& as prescribed
N (o&itor a&d report a&y uteri&e activity
N 6dmi&ister !@ fluid as prescribed
N (o&itor ! & )
N 6dmi&ister blood products as prescribed
N (o&itor blood studies
N +repare for the delivery of the fetus as Huic'ly as
possible
N (o&itor for si"&s of dissemi&ated i&travascular
coa"ulatio& i& the post-partum period
3o&firmatory 0est N ,ltrasou&d detects retro-place&tal bleedi&"
;ENA CA;A S=NDROME
?efi&itio& 0he ve&ous retur& to the heart is impaired by the wei"ht
of uterus#
Sy&o&ym Supi&e 7ypote&sive Sy&drome
2=5
+redisposi&" factors 0hrombophlebitis
*)0.<
3o&tribute to clot formatio& motio& i&clude
i&activity,reduced cordiac output, compressio& of the
vie&s i& pelvis or le"s
"he most li8ely cause of supine hypotension is feelin*
di22y3 short of breath and clammy )hen lyin* bac8 for
lon* periods of time in patients :
th
month of
pre*nancy.
"he cause of supine hypotension durin* pre*nancy
is the )ei*ht of the uterus compresses the inferior
#ena ca#a3 decreasin* the return of blood to the
heart3 thus decreasin* cardiac output3 )hich lo)ers
the blood pressure
!&itial si"& 8atiHue, pro1ymal &octur&al dysp&ea, orthop&ea,
hypo1ia, cya&osis
5ate Si"& /educe re&al perfectio&, ?ecrease "lomerular filtratio&
3ardi&al si"& shoc' such as tachycardia
*)0.<
3aused by reduced cardiac output, respiratory
distress, fatal distress
!&itial / Scree&i&" test 870 mo&itor
*)0.<
6bove 16B or below 12B beats per mi&utes, 8etal +7
below $#5
3o&firmatory test 6m&iotomy<
*)0.<
6bove 'eepi&" the si"&ifica&t other improved of the
pro"ress of care, the fatal status would he the
priority
*ursi&" ?ia"&osis 6ltered tissue perfectio& related to decrease blood
circulatio&
/is' for altered 7ealth mai&te&a&ce related to
i&sufficie&t '&owled"e of treatme&ts, dru"
therapies, home care ma&a"eme&t a&d preve&tio&
of future i&fectio&
6ltered comfort related to maladaptive copi&"
*ursi&" !&terve&tio& 3losely mo&itor for shoc' a&d decreasi&" blood#
+ressure, tachycardia, coal, clammy S'i&
(ai&tai& patie&t o& bed rest to reduce )1y"e&
dema&ds a&d ris' for bleedi&"# (o&itor prescribed
medicatio& "ive& to preserve ri"ht @e&tricular
felli&" pressure a&d i&crease blood pressure
!&struct patie&t i& self > care activities +rovide
i&formatio& about a&ti smo'i&" strate"ies a&d
allow patie&t time to retur& demo&stratio& of
treatme&t to the do&e at home
6ssess physical complai&ts matters of facts
without emphasi2i&" co&cer&# ,se deep >
breathi&", muscle rela1atio&, a&d ima"ery to
relieve discomfort# .1press a cari&" attitude
-est maor Sur"ery 3aesaria& Sectio& > &ote if cervi1 is i&complete deleted#
-est dirt for pre-operative 8ood a&d fluid are withheld before i&vasive procedure
2=6
is &ot resumed u&til the clie&t is stable a&d free of
&ausea & vomiti&"#
-est diet for ?isease 7ypoaller"e&ic !o&ic diet 3alcium i&creased
+ossible Sur"ical 3omplicatio& !&terruptio& of ve&a cava, which reduce cha&&el si2e#
3omplicatio& of ?isease N -leedi&" as a result of treatme&t
*)0.<
)bservatio& of the fetal mo&itori&" ofte& reveal
i&crease uteri&e rustli&" to&e, caused by failure of the
uterus to rela1 i& a& attempt to co&strict blood vesicle
a&d co&trol bleedi&"
N /espiratory failure#
-est positio& pre-operative Sims +ositio&
*)0.<
.urning to the le%t side to shi%t right o% the %etus o%%
the in%erior vena cava#
-ed Side .Huipme&t )1y"e& obtai& eHuipme&t for e1ter&al electro&ic fetal
heart rate mo&itori&" )1y"e& with 3a&&ula
Disse+inated )ntravascular
coagulation7istory of ?isease
6&"i&a, myocardial i&farctio&
3ool&ess a&d mottli&" of e1tremities9 pai&9
dysp&ea9 ab&ormal bleedi&"+redisposi&" /
3o&tributi&" 8actors
*ame of the ?isease
)verwhelmi&" i&fectio&s particularly bacterial sepsis9
F1 a0ru,tion ,lacenta' ecla+,sia' am&iotic fluid
embolism9 !,8?:!&tra-uteri&e fetal death; or rete&tio&
of dead fetus9 bur&9 trauma9 fractures9 maor sur"ery9
fat embolism9 soc'9 hemolytic tra&sfusio& reactio&9
mali"&a&cies particularly of lu&", colo&, stomach, a&d
pa&creas
NO"$1
,isseminated intra#ascular coa*ulation 0,IC7 is a
state of diffuse clottin* in )hich clottin* factors are
consumed. "his leads to )idespread bleedin*. Platelet
are decreased because they are consumed by the
process3 coa*ulation studies sho) no clot formation
0and are thus normal to prolon*ed7H and fibrin plu*s
may clo* the micro#asculature diffusely3 oo2in* from
in?ection sites3 and presence of hematuria are si*ns
associated )ith the presence of ,IC. S)ellin* and pain
in the calf of one le* are more li8ely to be associated
)ith thrompophlebitis. 0Saunders Comprehensi#e ACCA
$dition3 p. ECJ7
5ate Si"&!&itial Si"& 6ltered me&tal status9 acute re&al failure
*ursi&" ?ia"&osis & !&terve&tio& /is' for i&ury related to
bleedi&" due to thrombocytope&ia
2=$
6ltered tissue perfusio& :all
tissues; related to ischemia due to
microthrombi formatio&
?ecreased 8ibri&o"e& level9 i&creased fibri& split
products9 decreased a&ti-thrombi& !!! level-eside
.Huipme&t.349 3@+Scree&i&" or !&itial ?ia"&ostic
0est(i&imi2i&" -leedi&"
1# !&stitute -leedi&" precautio&s
2# (o&itor pad cou&t/amou&t of saturatio& duri&"
me&ses9 admi&ister or teach self-admi&istratio& of
hormo&es to suppress me&struatio& as prescribed#
3# 6dmi&ister blood products as ordered# (o&itor for
si"&s a&d symptoms of aller"ic reactio&s,
a&aphyla1is, a&d volume overload#
4# 6void dislod"i&" costs# 6pply pressure to sites of
bleedi&" for at least 2B mi&s, use topical
hemostatic a"e&ts# ,se tape cautiously#
5# (ai&tai& bed rest duri&" bleedi&" episode#
6# !f i&ter&al bleedi&" is suspected, assess bowel
sou&ds a&d abdomi&al "irth#
$# .valuate fluid status a&d bleedi&" by freHue&t
measureme&t fo vital si"&s, ce&tral ve&ous
pressure, i&ta'e a&d output#
=#
A# +romoti&" 0issue +erfusio&
1# Leep patie&t warm
2# 6void vasoco&strictive a"e&ts :systemic or
topical;#
3# 3ha&"e patie&tEs positio& freHue&tly a&d perform
/)( e1ercises#
4# (o&itor electrocardio"ram a&d laboratory test for
dysfu&ctio& of vital or"a&s casued by ischemia >
arrhythmias, ab&ormal arterial blood "ases,
i&creased blood urea &itro"e& a&d creati&i&e#
5# (o&itor for si"&s of vascular occlusio& a&d report
immediately#
a# -rai& > decreased level of co&scious&ess,
se&sory a&d motor deficits, sei2ures,
coma#
b# .yes > @isual deficits#
c# -o&e > +ai&
d# +ulmo&ary vasculature > chest pai&, short&ess
of breath, tachycardia#
e# .1tremities > cold, mottli&", &umb&ess#
f# 3oro&ary arteries > chest pai&, arrhythmias#
"# -owel > pai&, te&der&ess, decreased bowel
sou&ds#
+09 +009 +latelet cou&t :Smelt2er, S#3# & -are, -#4#,
1AA2#p#=11;
2==
h#
i#
#
6&ticoa"ula&t/efere&cesSmelt2er,S#3#& -are, -#4#
1AA2# -ru&&er a&d SuddarthEs 0e1boo' of (edical-
Sur"ical *ursi&", $
th
ed# K#-# 5ippi&cott compa&y<
+hiladelphia, ,S6#-est ?ru"3o&firmative 0est
0he 5ippi&cott (a&ual of *ursi&" +ractice, $
th
ed#,
2BB1# 5ippi&cott %illiams & wil'i&s<
+hiladelphia, ,S6# +p#==$-===#
7epari& i&hibits clotti&" compo&e&ts of ?!3
Natu'e of t#e D'u$
H!&e'eesis $'a)i(a'u
7yperemesis "ravidarum is persiste&t, u&co&trolled vomiti&" that be"i&s i& #the first wee's of pre"&a&cy a&d
may co&ti&ue throu"hout pre"&a&cy# ,&li'e Rmor&i&" sic'&ess,S hyperemesis ca& have serious complicatio&s,
i&cludi&" severe wei"ht loss, dehydratio&, a&d electrolyte imbala&ce#
N&.E" .he de%ining %actor %or h/,ere+esis gravidaru+ should 0e the ti+e o% occurrence U and that is the
2nd tri+ester5 usuall/ the 1B U 1H
th
6ee4. )% this is on the 1
st
tri+ester5 usuall/ this is +orning sic4ness.
Causes
4o&adotropi&e productio&
+sycholo"ical factors
0rophoblastic activity
Assessent *in(in$s
3o&ti&uous, severe &ausea a&d vomiti&"
?ehydratio&
?ry s'i& a&d mucous membra&es
.lectrolyte imbala&ce
(etabolic acidosis
*o&-elastic s'i& tur"or
)li"uria
Dia$nostic Test Result
6rterial blood "as a&d a&alysis reveals al'alosis#
7b level a&d 730 are elevated#
Serum potassium level reveals hypo'alemia
,ri&e 'eto&e levels are elevated#
,ri&e specific "ravity is i&creased#
Nu'sin$ Dia$noses
8luid volume deficit
6ltered &utritio&9 less tha& body reHuireme&ts
+ai&
T'eatent
0otal pare&teral &utritio& :0+*;
/estoratio& of fluid a&d electrolyte bala&ce
2=A
D'u$ T#e'a&!
6&ti-emetics, as &ecessary for vomiti&", for e1ample +lasil , 7ydro1y2i&e a&d +rochlorpera2i&e
Inte')ention an( Rationales
(o&itor vital si"&s a&d fluid i&ta'e a&d output to assess for fluid volume deficit#
)btai& blood samples a&d uri&e specime&s for laboratory tests, i&cludi&" 7b level, 730, uri&alysis,
a&d electrolyte levels#
+rovide small freHue&t meals to mai&tai& adeHuate &utritio&#
(ai&tai& !#@# fluid replaceme&t a&d 0+* to reduce fluid deficit a&d p7 imbala&ce#
+rovide emBotio&al support to help the patie&t cope with her co&ditio&#
"eachin* "opics
,si&" salt o& foods to replace sodium lost by vomiti&"#
8rom< Spri&"house, pa"es 4=3-4=4
I;. INTRA"ARTUM CARE
Int'a&a'tu &e'io( e1te&ds from the be"i&&i&" of co&tractio&s that cause cervical dilatio& to the first 1-4
hours after delivery of the &ewbor& a&d place&ta#
Int'a&a'tu ca'e refers to the medical a&d &ursi&" care "ive& to a pre"&a&t woma& a&d her family duri&"
labor a&d delivery#
5abor versus 5abor
1# 5abor< 3oordi&ated seHue&ce of i&volu&tary uteri&e co&tractio&s or a result i& the effaceme&t a&d dilatio&
of the cervi1, followed by e1pulsio& of the products of co&ceptio&#
2# ?elivery< 6ctual eve&t of birth
A. *acto's Affectin$ Labo'
*ACTORS A**ECTING LA1OR
+6SS64.%6F +6SS.*4./ +)%./S +563.*065
8630)/S
+SF37.
?iscomfort-e"i&s at lower bac' a&d radiates
arou&d abdome&+rimarily o& the lower abdome&
&
"roi&!rre"ular0/,.865S.3o&tractio&s/e"ular4y&ecoi
d
8etal bo&es
Suture li&es
8o&ta&els head
measureme&ts
8etal lie
+76S.S
N !&creme&t
N 6cme
N ?ecreme&t
2AB
,&cha&"ed
,&cha&"ed or decrease i& freHue&cy a&d i&te&sity
-ecome more freHue&t
4radual i&crease i& duratio& a&d i&te&sity / pro"ressive
freHue&cy & i&te&sity
I "ASSAGE?A=
-refers to the adeHuacy of the pelvis a&d birth ca&al i&
allowi&" the fetal desce&t9 factors i&clude<
6# 0ype of pelvis
-# structure of the pelvis :true versus false pelvis;
3# pelvic i&let diameters
?# ability of the uteri&e se"me&t & va"i&al ca&al to diste&d,
the cervi1 to dilate
A**ECTED 1= THE *OLLO?ING *ACTORSA
A. T!&es of St'uctu'e
PartsA ischium, iluim, coccy1#
Eoints" Sacroiliac, Sacrococcy"eal, symphysis pubis :all softe& duri&"
pre"&a&cy;
#lassi%ications or ./,es o% Pelvis"
a# G!necoi(A *ormal 8emale +elvis< /ou&ded )val#
b# 7&S. (AV&ABLE (& S!##ESS(!L
LAB& A B).*.
c# An('oi(A *ormal (ale +elvis< 8u&&el Shape
d# Ant#'o&oi(A oval
e# "lat!&elloi(A flatte&ed, tra&sverse oval
f#
B. St'uctu'e of t#e "el)is :<it# &el)ic inlet & outlet
(iaete's+
#.
D.
E.
(.
G.
*. *ALSE "EL;IS
). 6bove the li&ea termi&alis, across the top of symphysis
pubis# !t supports the e&lar"e uterus i& the abdomi&al
cavity
M Shallow upper basi& of the pelvis
M Supports the e&lar"i&" uterus but &ot importa&t
obstetrically
M LINEA TERMINALIS
M +la&e dividi&" upper or false pelvis from lower or true
pelvis
8etal attitude
8etal prese&tatio&
8etal positio&
8etal statio&
6SS.SS(.*0
8reHue&cy
?uratio&
!&terval
!&te&sity
2A1
M TRUE "EL;IS
M 5ies below the li&ea termi&alis, the bo&y pelvis
throu"h which the baby pass
M %idest diameter :tra&sverse;
M *arrowest diameter :a&terior > posterior;
M 3o&sists of the pelvic i&let, pelvic cavity, a&d pelvic
outlet#
M -o&y ca&al throu"h which the i&fa&t pass#
M (easureme&ts of true pelvis i&flue&ce the co&duct a&d
pro"ress of labor a&d delivery#
M MID"LANE
M +elvic cavity
M
M
M
M
M OUTLET
M ?i(est (iaete'A 6&terior posterior diameter :reHuires
the i&ter&al /elatio&ship of fetal head for e&try;
M Na''o<est (iaete'< 0ra&sverse !&tertuberous ?iameter
:facilitates delivery i& )ccipital 6&terior +osterior;
M
M
M 1%. "el)ic easu'eents
M a. T'ue conNu$ate o' conNu$ate )e'a
M - measured from upper mar"i& of symphysis pubis to
sacral promo&tory9 should be at least 11 cm#
M - may be obtai&ed by 1-ray or ,/S
M b. Tube'9isc#ial (iaete'/
Inte'tube'ous (iaete'
M 9 (easures the outlet betwee& the i&&er
borders of ischial tuberosities, should be at least =-A
cm#
M - estimated o& pelvic e1am
M c. Obstet'ical ConNu$ate
M - ?ista&ce betwee& the i&&er surfaces
of the symphysis pubis a&d sacral promo&tory
M
M
M II. "ASSENGER :T#e *etus+
M Refe's to t#e fetus an( its abilit! to
o)e t#'ou$# t#e &assa$e<a!.
M A**ECTED 1= THE *OLLO?ING *ACTORS<
M
M a# Attitu(e
M
M 1# 0he relatio&ship of the fetal body parts to o&e a&other
or, a&other word is fetal posture
M
M 2# Nor+al intrauterine attitude is %le$ion, i& which the
fetal bac' is rou&ded, the head is forward o& the chest, a&d
the arms a&d le"s are folded i& a"ai&st the body
M
M - Lie
M - /elatio&ship of the spi&e of the fetus to the spi&e of the
2A2
mother
M
M .ransverse lie is an indication for cesarean deli#ery.
Se#eral maternal and fetal conditions ma8e cesarean
deliver/ necessary ."he commonly accepted indications
include complete placenta pre#ia3 trans#erse lie at term3
cephalopel#ic disproportion3 abruptio placentae3 acti#e
*enital herpes3 umbilical cord prolapse3 failure to
pro*ress in labor3 pro#en fetal distress3 beni*n and
mali*nant tumors that bloc8 the birth canal3 and cer#ical
cercla*e. Other reasons for a cesarean deli#ery are more
contra#ersial3 such as breech presentation3 pre#ious
cesarean birth3 ma?or con*enital anomalies3 and se#ere
isoimmuni2ation. ")ins can sometimes be deli#ered
#a*inally3 especially )hen the lo)ermost t)in is in a
#erte@ presentation.
M
M
M 1### Lon$itu(inal o' )e'tical
M a# 8etal spi&e is parallel to the motherIs spi&e
M b# 8etus is either cephalic or breech prese&tatio&
M 2### T'ans)e'se o' #o'i3ontal
M a# 8etal spi&e is at a ri"ht a&"le, or perpe&dicular, to the
motherIs spi&e
M b# +rese&ti&" part is the shoulder
M c# ?elivery by cesarea& sectio&
M 3... ObliFue
M a# 8etal spi&e is at a sli"ht a&"le from a true hori2o&tal lie
M b# ?elivery is by cesarea& sectio& if u&correctable
M
M 3 "'esentation
M 9 the relatio&ship of a particular refere&ce poi&t of the prese&ti&"
part a&d the mater&al pelvis described with a series of 3 letters or
presentation refers to the part of the fetus at the cer#ical os
M
M +rese&ti&" part< +ortio& of the fetus that e&ters the pelvis
first
M 1# 3ephalic
M a# 0he most commo& prese&tatio&
M b# 8etal head prese&ts first
M 2 -reech
M a# -uttoc's prese&t first
M b# ?elivery by cesarea& sectio& may be
reHuired, althou"h it is ofte& possible to deliver va"i&ally
M 3 Shoulders
M a# 8etus is i& a tra&sverse lie, or the arm, bac',
abdome&, or side could prese&t
M b# !f the fetus does &ot spo&ta&eously rotate or if it is
&ot possible to tur& the fetus ma&ually, a cesarea& sectio& may
be performed
M
M *)0.< "he nurse )ould auscultate abo#e the umbilicus
if the fetus is in breech presentation has the bac8 abo#e or at the
umbilical area. %etal heart tones are ausculated best in the left
2A3
lo)er abdomen )hen the fetus is in a left occipitoanterior
position. %or the heart tones to be located belo) the umbilicus3
the fetus )ould be in a cephalic position. %etal heart tones are
heard best in the ri*ht lateral abdomen )hen the fetus is in a
ri*ht occipitoposterior position.
M ?# "osition
M /elatio&ship of assi"&ed area of the prese&ti&" part or
la&dmar' to the mater&al pelvis or the relationship of the
fetusGs presentin* part to the motherGs pel#is
M
M LEO"OLDOS MANEU;ERS
M
M It is a systematic )ay to e#aluate the presentation3
position and attitude of the fetusH the location of the best
place to auscultate the fetal heart soundsH and the
en*a*ement status of the presentin* part. .he/ don<t
accuratel/ deter+ine ho6 large the %etus is5 6hich is
0est deter+ined 0/ ultrasound.
M
M +reparatio&
M
M 1# 6s' the mother to empty the bladder
M 2# %arm ha&ds a&d apply them to the abdome& with firm
a&d "e&tle pressure
M
M +/)3.?,/.
M
M .he %irst +aneuver deter+ines 6hat %etal ,art is in the
%undal ,ortion o% the uterus. )n this case5 the so%t5 %ir+
+ass indicated the %etal 0uttoc4s are in the %undus5
re%lecting a verte$ ,resentation. .he second +aneuver
docu+ents the location o% the %etal 0ac4. .he side o%
the uterus 6here the 0ac4 is located is s+ooth and
conve$ to the touch5 and the o,,osite side has areas o%
indentation. .he third +aneuver con%ir+s that 6as
6hat ,al,ated in the %undus is correct and also
deter+ines 6hether the ,resenting ,art is engaged. )n
this case5 the hard5 round5 +ova0le o0Gect in the ,u0ic
area is the %etal head. .he %ourth +aneuver deter+ines
id the %etal head is %le$ed or e$tended.
M
M (etal Position
M
M /)6< /i"ht occiput a&terior
M 5)6< 5eft occiput a&terior (the 0est %etal ,osition9
M /)+< /i"ht occiput posterior
M /(6< /i"ht me&tum a&terior
M /(+< /i"ht me&tum a&terior
M 5)+< 5eft occiput posterior
M 5(6< 5eft me&tum a&terior
M /)0< /i"ht occiput tra&sverse
M 5)0< 5eft occiput tra&sverse
M /(+< /i"ht me&tum posterior
M 5S6< 5eft sacrum a&terior
M 5S+< 5eft sacrum posterior
M
2A4
M Se#ere bac8 pain durin* labor maybe related to a fetus in
an OCCIPI"O. POS"$IO POSI"ION. "his means that
the fetal head presses a*ainst the client/s sacrum3 )hich
causes mar8ed discomfort durin* contractions.
epositionin* the client and pro#idin* sacral bac8 rubs
may help alle#iate the discomfort. "rans#erse3 obli4ue
and occiput positions do not cause pressure on the
sacrum.
M
M 0. *etal Lie 9 refers to the relationship of the fetal lon*
a@is to that of the motherGs lon* a@is.
M a# CE"HALIC Q verte1, face, brow
M b# 1REECH > fra&', footli&", complete
M c# SHOULDER > tra&sverse lie
M
M N&.E1 Adolescent clients maturation are usually not yet
complete3 therefore they are #ery common for
cephalopel#ic disproportion.
M
M N&.EA 5ie :spi&e to spi&e; may be lo&"itudi&al
:parallel;, tra&sverse :ri"ht a&"les;, obliHue :sli"ht a&"le
off true tra&sverse lie;#
M
M *ETAL RE*ERENCE "OINT :"RESENTING "ART+
M
M 6# )33!+,0 :);
M -# S63/,( :S;
M 3# S36+,56 :Sc;
M ?# (.*0,( :(;
M
M MATERNAL RE*ERENCE "OINT
M
M 1# S!?. )8 (60./*65 +.5@!S
M 6# 5eft :5;
M -# /i"ht :/;
M 3# 0ra&sverse :0;
M
M 2# +6/0 )8 07. (60./*65 +.5@!S
M 6# 6&terior :6;
M -# +osterior :+;
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
2A5
M
M
M
M
M
M
M
M
M
M
M 1'eec# "RESENTATIONS
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M *RANH 1REECH
*ULL / COM"LETE
M
1REECH
"RESENTATION
M
M
M
M
M
M
M
M
M
2A6
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
SHOULDER 1REECH
M
M
*OOTLING "RESENTATION
M III. "O?ER
M
M 9 /efers to the freHue&cy, duratio&, a&d stre&"th of uteri&e
co&tractio&s to cause complete cervical effaceme&t a&d
dilatio&#
M
M 0he forces acti&" to e1pel the fetus
1# EffaceentA Shorte&i&" a&d thi&&i&" of the cervi1 duri&"
the first sta"e of labor
2# Dilation< .&lar"eme&t of cervical os a&d cervical ca&al
duri&" first sta"e
3#
.. LA1OR CONTRACTIONS
5#
4. THREE "HASES O* CONTRACTION
5.
1# INCREMENT- steep cresce&t slope from be"i&&i&" of
the co&tractio& u&til its pea'#
2. ACME/"EAH > stro&"est i&te&sity#
2. DECREMENT > dimi&ishi&" i&te&sity#
B.
3. CHARACTERISTICS O* CONTRACTIONS
H.
I. *REGUENC= > be"i&&i&" of o&e co&tractio& to
be"i&&i&" of o&e co&tractio&# 5ess tha& 2 mi&utes should
be reported#
@. DURATION > be"i&&i&" of o&e co&tractio& u&til its
completio&#
2A$
(ore tha& AB seco&ds should be reported
because of uteri&e rupture or fetal distress#
J. INTENSIT= > the stre&"th of co&tractio& at its pea' may
be mild, moderate or stro&"#
1:.
11.
12. I;. "LACENTAL *ACTORS
12. - /efers to the site of place&tal i&sertio&#
1B.
13.
1H. ;. "S=CHE
1I. - /efers to the clie&tEs psycholo"ical state, available
support systems, preparatio& for birth, e1perie&ces, a&d
copi&" strate"ies#
1@.
1J.
2:. 1. LA1OR
21. %. Si$ns of i&en(in$ labo'
22. -. Co&a'ison of T'ue Labo' f'o *alse
Labo'
22. 3. Sta$es of labo'
2B. 3. a. station of t#e &'esentin$ &a't
23. .. Nu'sin$ Inte')entions (u'in$ labo' &
(eli)e'!
2H. 0. Assessin$ t#e *etal Hea't Rate
2I.
2@.
2J. SIGNS O* IM"ENDING LA1OR
2:.
21.
22. 5i"hte&i&" -ra1to&Es-7ic's co&tractio&
4astroi&testi&al upset -urst of e&er"y -lood
show
22.
2B. F1 sign o% la0or
u,tured 0ag o% 6ater
23.
2H.
2I.
2@. %. "REMONITOR= SIGNS O* LA1OR
%. 5!470.*!*4
-. - ?esce&t of the fetus a&d uterus i&to pelvic cavity
before labor o&set#
3. -)ccurs 2-3 wee's earlier i& primipara#
.. - !& multipara, may &ot occur u&til labor be"i&s#
0. 2# 3./@!365 376*4.S
4. a# E**ACEMENT
5. - +ro"ressive softe&i&" Rripe&i&"S a&d thi&&i&" of
the cervi1#
6. - R-5))?F S7)%S :e1pulsio& of mucous plu";
7. b# DILATION
%8. - )pe&i&" of cervical os duri&" labor#
%%. 3# /e"ular -ra1to& 7ic'sE co&tractio&s#
%-. 4# /upture of am&iotic membra&es#
%3. 5# *.S05!*4 -.76@!)/S
%.. 6# %ei"ht loss of about 1-3 lbs 2-3 days before labor
2A=
o&set#
%0.
%4. -. COM"ARISON O* TRUE AND *ALSE LA1OR
%5.
%6. 376/630./!S0!3S
6&thropoid
6&droid
+latypelloid
.ffects of wal'i&"Stress factors6bruptio place&ta
5eadi&" to hypoto&ia
+lace&ta previa
+lace&ta acreta
+lace&ta media
3o&tractio&s are
i&te&sified
5esse&ed or
&ot affected
3ervical cha&"es +ro"ressive
dilatio& a&d
effaceme&t
*o cha&"e
+ai& does&Et disappear+ai& disappears?uri&"
Sedatio&3o&tractio&s does&Et stop3o&tractio&s
stopsShow
+rese&t *ot prese&t
?uri&" sleep
3. STAGES O* LA1OR
1
S0
S064. 2
*?
S064. 3
/?
S064. 4
07
S064.
3o&tractio& to
dilatio&
"'e&a'ato'!
(i)isionA
1; 5ate&t phase B-
3 cm
?uratio&< 3B >
45 seco&ds
*)0.< Pushin*
durin* the first
sta*e of labor
)hen the ur*e is
felt but the cer#i@
is not yet fully
dilated may
produce cer#ical
s)ellin* and
ma8es labor more
difficult. "he
client should be
encoura*ed to
PAN" (LO6 or
8ull cervical
dilatatio& to
delivery
?elivery to
place&tal
e1pulsio&
"he nurse
should
8no) if the
placenta is
*oin* to be
deli#ered3 is
to )atch for
cord
len*thenin*
3 a sli*ht
*ush of
dar8ened
blood or a
chan*e in
fundal
shape.
1
st
4 hours
postpartum
"he
precautions
you should
ta8e )hen a
postpartum
client starts
ambulatin* are
the fall
precaution and
close
monitorin*
should be done
due to the ris8
of syncopy3
especially the
first fe) times
out of bed.
2AA
(LO6.(LO6
pattern of
breathin* to help
o#ercome the ur*e
to push.
2; 6ctive phase 4-
$ cm
Du'ationA .0948
secon(s
3; 0ra&sitio&al
phase =-1B cm
?uratio& < 6B-AB
seco&ds
*IRST STAGE O* LA1OR
:ONSET O* REGULAR CONTRACTIONS TO *ULL CER;ICAL DILATION
.ANS).)&N P*ASE
0!(.< +/!(!+6/6 :1hour;
(,50!+6/6 :1B > 15 mi&utes;
3./@!O<
.8863.(.*0 - 1BBC
?!560!)* - =-1B cm
3)*0/630!)*S
8/.V,.*3F - 2-3 mi&utes
?,/60!)* - 6B-AB seco&ds
(6*!8.S060!)*S<
3lie&t may be irritable a&d pa&ic'y9 (ay lose co&trol9 6m&esic betwee& co&tractio&s9 +erspiri&",
&auseous a&d vomiti&" commo&9 0rembli&" of le"s9 +ressure o& bladder a&d rectum9 -ac'ache9 !&creased
show9 3ircumoral pallor
NO"$1 If the client is in acti#e labor and there is no chan*e in dilation after A hours3 the nurse should suspect
cephalopel#ic disproportion. "he client is not e@periencin* a prolon*ed latent phase 0C.E cm73 prolon*ed
transitional phase 0pushin*73 and contraction pattern.
NO"$1&a*inal $@amination
"o determine if the client is fully dilated3 the nurse performs a #a*inal e@amination. "o assess the
suture most readily felt3 the nurse )ould determine the position of the cranial suture termed.SA-I"ALL
SU"U$.
3BB
STATION
/efer to the level of prese&ti&" part of fetus i& relatio& to ima"i&ary li&e betwee& ischial spi&es :2ero
statio&; i& mid pelvis of mother#
- 0he measureme&t of the pro"ress of desce&t i& ce&timeters above or below the midpla&e from the
prese&ti&" part to the ischial spi&e
Minus stationA abo)e isc#ial s&ine
90 to Q% in(icates a &'esentin$ &a't abo)e 3e'o station :93*LOATINGD 9% DI""ING+
Station 8A at isc#ial s&ine
: +eans ENGAGE7EN.
"lus stationA belo< isc#ial s&ine
R % TO R 0 in(icates a &'esentin$ &a't belo< 3e'o station
R3 #&1N)NG
NMy baby is comin*O3 the R9 nursin* inter#ention is to loo8 for perineal bul*in* 0cro)nin*7. If the
perineum is bul*in*3 the patient should be coached to pant )ith her contractions so that she doesn/t
push. %etal heart rate is focus on the labor process or potential fetal cord compression and meconium
stained complications
SECOND STAGE O* LA1OR
:COM"LETE CER;ICAL DILATION TO 1IRTH O* NE?1ORN+
0!(.
+/!(!+6/6 :3B-5B mi&utes ;
(,50!+6/6 :2B mi&utes;
3)*0/630!)*S
8/.V,.*3F - 2-3 mi&utes
?,/60!)* - 6B-AB seco&ds
!*0.*S!0F
@./F 76/?< 1BB mm 7"
(6*!8.S060!)*S<
?ecrease i& pai& from tra&sitio&al level9 i&creased bloody show9 .1cited ea"er a&d i& co&trol#
3B1
THIRD STAGE O* LA1OR
:DELI;ER= O* NE?1ORN TO DELI;ER= O* "LACENTA+
0!(.< 5-3B mi&utes
3)*0/630!)*S
Stro&" a&d well-co&tracted uterus cha&"i&" to "lobular shape
(6*!8.S060!)*S<
Increased *ush of blood
Uterus becomin* *lobular )ith fundus risin* in the abdomen
Apparent len*thenin* of cord
*OURTH STAGE O* LA1OR
:DELI;ER= O* "LACENTA TO HOMEOSTASIS+
0!(.
,sually defi&ed as the first hour postpartum# 0his sta"e lasts from 1-4 hours after birth#
,0./,S
0he uterus co&tracts i& the midli&e of the abdome& with the fu&dus midway betwee& the umbilicus a&d
symphysis pubis#
(6*!8.S060!)*S<
5ochia rubra
.1ploratio& of &ewbor&
+are&t-i&fa&t bo&di&" be"i&s
*ewbor& alert a&d respo&sive
8irst period of reactivity
NURSING INTER;ENTIONS DURING LA1OR AND DELI;ER=
M ?uri&" labor, mo&itor 87/#
M +rovide patie&t comfort#
M 6dmi&ister a&al"esics as i&dicated#
M +repare for delivery#
M !mmediate &ewbor& care at delivery#
- .stablish airway#
- )bserve 6p"ar score at 1 a&d 5 mi&utes i&terval#
- 3lamp umbilical cord#
- (ai&tai& warmth#
- 6ssess the &ewbor&Es "estatio&al a"e#
- 6dmi&ister prophylactic eye drops a&d vitami& L#
- +lace ide&tificatio& ba&d o& baby a&d mother#
NURSING CARE DURING LA1OR
3B2
Nursin* care for the client durin* the second sta*e of labor should include assistin* the mother )ith pushin*3 helpin* position her le*s for ma@imum pushin* effecti#eness3 and monitorin* the fetal heart rate
3B3
Mec#aniss of Labo' En$a$eent o' Ca'(inal o)eents b! t#e *etus
Definition< (echa&ism by which the fetus &estles i&to the pelvis# 6 co&ti&uous process from the time of
e&"a"eme&t u&til birth, a&d is assessed by the measureme&t called statio&
Descent
6lso termed li"hte&i&" or droppi&" ?esce&t
0he process that the fetal head u&der"oes as be"i&s its our&ey throu"h the pelvis
*le,ion +rocess of the fetal headIs &oddi&" forward toward the fetal chest
Su0occi,oto0reg+aticA the diameter that prese&ts to the mater&al pelvis duri&" COMPL$"$ %L$'ION#
3B4
Inte'nal Rotation
!&ter&al rotatio& of the fetus9 most commo&ly from the occipital tra&sverse positio&, assumed at e&"a"eme&t
i&to the pelvis, to the occipital a&terior positio& while co&ti&uously desce&di&"
E,tension
.&ables the head to emer"e whe& the fetus is i& a cephalic positio&
-e"i&s after the head crow&s !s complete whe& the head passes u&der the pubis a&d occipital, a&d the a&terior
fo&ta&el, brow, face, a&d chi& pass over the sacrum a&d coccy1 are over the peri&eum
/estitutio&
/eali"&me&t of the fetal head with the body after that head emer"es
E,te'nal Rotation
0he shoulders e1ter&ally rotate after the head emer"es a&d restitutio& occurs, so that the shoulders are
a&teroposterior diameter of the pelvis
E,&ulsion
0he delivery baby
CARDINAL MO;EMENTS O* THE *ETUS
?esce&t 8le1io& !&ter&al /otatio& .1te&sio& .1ter&al /otatio&
.1pulsio&
8i"ure 1= 3ardi&al (oveme&ts or (echa&ism of labor
;II. ANESTHESIA
NOTEA Analgesia ad+inistered during the second stage o% la0or includes continuation o% the lu+0ar
e,idural 0loc45 ,udendal 0loc45 and local in%iltration o% the ,erineu+. Narcotic analgesics and ,ericervical
0loc4 are ad+inistered during the active ,hase o% la0or. A s,inal 0loc4 is given during the active ,hase o%
the %irst stage o% la0or. Sedative h/,notics5 i% ad+inistered5 are given 6hen the ,atient is in earl/ latent la0or
to encourage rest. A s,inal 0loc4 is given during the active ,hase o% the %irst stage o% la0or.
N&.E" *)0.< "he chief concepts of La+a8e teaching include conditioned responses to stimuli throu*h use of
a focal point. An emotionally satisfyin* e@perience is promoted rather than discoura*in* use of anal*esia and
anesthesia.
3B5
?.S3.*0 85.O!)* !*0./*65
/)060!)*
.O0./*65
/)060!)*
.O0.*S!)*
.O+,5S!)*
6# 5ocal a&esthesia
1# ,sed for bloc'i&" pai& duri&" episiotomy
2# 6dmi&istered ust before the birth of baby
3# *o effect o& the fetus
-# +aracervical bloc'
1# ,sed i& the first sta"e of labor
2# +rovides a rapid bloc' of uteri&e pai&
3# *o effect o& the peri&eal area
4# *o effect o& the ability to bear dow&
5# (ay cause fetal bradycardia
3# +ude&dal bloc'
1# 6dmi&istered ust before the birth of the baby
2# !&ectio& site at pude&dal &erve throu"h a tra&sva"i&al route
3# -loc's peri&eal area for episiotomy
4# .ffect lasts about 3B mi&utes
5# *o effect o& co&tractio&s or fetus
*)0.< Pudendal (loc8 Anesthesia
"he R9 purpose is to relie#e pain primarily in the perineum and #a*ina. It does not relie#e pain primarily
in the perineum and #a*ina. Pudendal bloc8 is ade4uate for episiotomy and its repair.
"he fetus should be assessed for (A,5CA,IA )hich is a potential complication of pudendal bloc8
anesthesia. ,ecrease mo#ements3 increase #ariability and meconium stained are NO" associated.
Maternal Ad#erse effects are the follo)in*1 hypotonia3 reduced responsi#eness and sei2ures.
?# .pidural bloc'
1# !&ectio& site i& epidural space at 53-54
2# 6dmi&istered after labor is established or ust before a scheduled cesarea& birth
3# /elieves pai& from co&tractio&s a&d &umbs va"i&a a&d peri&eum
4# (ay cause hypote&sio&
5# Does not cause headache 0ecause the dura +ater is not ,enetrated
6# 6ssess mater&al blood pressure
$# (ai&tai& the mother i& side-lyi&" positio& or place a rolled bla&'et be&eath the ri"ht hip to displace the
uterus from the ve&a cava
=# 6dmi&ister !@ fluids as prescribed A# !&crease fluids as prescribed if hypote&sio& occurs
A# 0he maor complicatio& of epidural a&esthesia is mater&al hypote&sio&#
N&.E" "o minimi2e the hypertensi#e effects of epidural anesthesia prior to the procedure ade4uately
hydrate the patient and position the patient side lyin* to the left.
After epidural anesthesia the #ital si*ns should be monitored e#ery 9.A minutes for the first 9F minutes.
.he assess+ent should 0e a high ,riorit/ a%ter a ,atient has received an e,idural is 0lood ,ressure
0ecause an e,idural can cause h/,otension and its 0loc4s the autono+ic nervous s/ste+.
A patient )ho is about to recei#e epidural anesthesia should empty her bladder before the procedure
because an epidural )ill lessen the sensation to #oid so #oidin* no) may decrease the need for
catheteri2ation later.
*)0.<
3B6
A co++on adverse e%%ect o% e,idural anesthesia is h/,otension5 6hich 6ould cause i+,aired gas
e$change in the %etus. .o ,revent h/,otension5 the ,atient receives a 0olus o% 3:: to 15::: +l o% ).V.
%luid 0e%ore the ,rocedure. .he ,atient isn<t a%%ected 0/ these ,ro0le+s 0ecause she didn<t receive the
e,idural anesthesia.
*)0.< "he patient plans to recei#e an epidural anesthetic for pain relief durin* labor3 it )on/t be
administered until the patient is dilated J to F cm.
.# Spi&al bloc'
1# !&ectio& site i& spi&al subarach&oid space at 53-55
2# 6dmi&istered ust before birth
3# /elieves uteri&e a&d peri&eal pai& a&d &umbs va"i&a, peri&eum, a&d lower e1tremities
4# (ay cause mater&al hypote&sio&
5# (ay cause postpartum headache
6# 0he mother must lie flat = to 12 hours followi&" spi&al i&ectio&
$# +lace a rolled bla&'et u&der the ri"ht hip to displace the uterus from the ve&a cava
=# 6dmi&ister !@ fluids as prescribed
8# 4e&eral a&esthesia
1# (ay be used for some sur"ical i&terve&tio&s
2# 0he mother is &ot awa'e
3# +rese&ts a da&"er of respiratory depressio& vomiti&"
O1STETRICAL "ROCEDURES
6# )1ytoci& !&ductio&
1# 6 deliberate i&itiatio& of uteri&e co&tractio&s this stimulates labor
2# .lective i&ductio& may be accomplished ! o1ytoci& :+itoci&; i&fusio&
3# )btai& baseli&e traci&" of uteri&e co&tractio&s a&d 87/
4# !&crease !@ dosa"e of o1ytoci& as prescribed o&ly after assessi&" co&tractio&s, 87/, a&d mater&al blood
pressure a&d pulse
5# ,o not increase rate of o@ytocin once the desired contraction pattern is obtained 0contraction fre4uency
of A to E minutes and lastin* :C seconds7
6# ,iscontinue o@ytocin as prescribed contraction fre4uency is less than A minutes or duration more than TC
seconds3 or if fetal distress is note
*)0.< )1ytoci& :!&ductio& of 5abor;
(efore the induction of Labor3 the nurse should obtain a baseline measurement of the fetal heart rate. If
the fetal heart rate pattern sho)s fetal distress3 the client is not a candidate or if contractions occur less
than A minutes apart or last lon*er than :C seconds
3# Anioto!
1# 6rtificial rupture of membra&es :6/)(;9 performe by the physicia& to stimulate labor
2# +erformed if the fetus is at ZBZ or ZUZ statio&
3# !&creases ris' of prolapsed cord a&d i&fectic
3B$
4# (o&itor 87/ before a&d after 6/)(
5# /ecord time of 6/)(, 87/, a&d characteristic of fluid
6# (eco&ium-stai&ed am&iotic fluid may be associated with fetal distress
$# -loody am&iotic fluid may i&dicate abrupt place&tae or fetal trauma
=# 6& u&pleasa&t odor to am&iotic fluid is associated with i&fectio&
A# +olyhydram&ios is associated with mater&al diabetes a&d certai& co&"e&ital disorders
1B# )li"ohydram&ios is associated with i&trauteri&e "rowth retardatio& :!,4/; a&d co&"e&ital
disorders
? #E,te'nal )e'sion
1# .1ter&al ma&ipulatio& of the fetus from a& ab&ormal positio& i&to a &ormal prese&tatio&
2# !&dicated for a& ab&ormal prese&tatio& that e1ists after the 34th wee'
3# (o&itor vital si"&s
4# !f the mother is /h-&e"ative, e&sure that /7 immu&e "lobuli& was "ive& at 2= wee's "estatio&
5# +repare for &o&stress test to evaluate fetal well-bei&"
6# !@ fluids a&d tocolytic therapy may be admi&istered to rela1 the uterus a&d permit easier ma&ipulatio& of
fetus
$# ,ltrasou&d is used duri&" the procedure to evaluate fetal positio& a&d place&tal placeme&t a&d "uide
directio& to the fetus
=# 6bdomi&al wall is ma&ipulated to direct fetus i&to a cephalic prese&tatio& if possible
A# (o&itor blood pressure to ide&tify ve&a cava compressio&
1B# (o&itor for u&usual pai&
11# 8ollowi&" the procedure
a# +erform &o&stress test to evaluate fetal well-bei&"
b# #(o&itor for uteri&e activity, bleedi&", ruptured membra&es, a&d decreased fetal activity
c# %ith /h-&e"ative clie&ts, perform Lleihauer -et'e test as prescribed to detect the prese&ce a&d
amou&t of fetal blood i& the mater&al circulatio& a&d to ide&tify clie&ts who &eed additio&al /h
immu&e "lobuli&
i# E&isioto!
J "he purpose of episiotomy is to shorten the A
nd
sta*e of labor3 substitutes a clean sur*ical incision for
a tear and decreases undue stretchin* of perineal muscles. An episiotomy helps pre#ent tearin* of the
rectum but does not necessarily relie#e pressure on the rectum. An episiotomy does not pre#ent perineal
edema3 ensure 4uic8 deli#ery of the placenta or cause enlar*in* the pel#ic inlet.
1# !&cisio& made i&to peri&eum to e&lar"e va"i&al outlet a&d facilitate delivery
2# 3hec' episiotomy site
3# !&stitute measures to relieve pai&
4# +rovide ice pac' duri&" the first 24 hours
5# !&struct the clie&t i& the use of sit2 baths
6# 6pply a&al"esic spray or oi&tme&t as prescribed
$# +rovide peri&eal care, usi&" clea& tech&iHue
=# !&struct the clie&t i& the proper care of the i&cisio&
A# !&struct the clie&t to dry the peri&eal area from fro&t to bac' a&d to blot the area rather tha& wipe it
1B# !&struct the clie&t to shower rather tha& bathe i& a tub
11# 6pply a peripad without touchi&" the i&side surface of the pad
3B=
12# /eport a&y bleedi&" or dischar"e to the physicia&
13# "he ad#anta*e of an episiotomy is that it facilitates the deli#ery of the fetus3 it pre#ents tearin* of the
perineum3 and it pre#ents undo stretchin* of the perineal muscles.
8# *o'ce&s (eli)e'!
1# 0wo double-crossed, spoo& li'e articulated blades that are used to assist# i& the delivery of the fetal head
2# /eassure the mother a&d e1plai& the &eed for forceps
3# (o&itor mother a&d fetus duri&" delivery possible i&ury
5# 6ssist with repair of a&y laceratio&s
4# ;acuu e,t'action
1# 6 cap li'e suctio& device is applied to the fetal head to facilitate e1tractio&
2# Suctio& is used to assist i& delivery of the fetal head
3# 0ractio& is applied duri&" uteri&e co&tractio&s u&til desce&t of the fetal head is achieved
4# 0he suctio& device should &ot be 'ept i& place a&y lo&"er tha& 25 mi&utes
5# (o&itor 87/ every 5 mi&utes if e1ter&al fetal mo&itori&" is &ot used
6# 6ssess &ewbor& i&fa&t at birth a&d throu"hout postpartum period for si"&s of cerebral trauma
$# (o&itor for developi&" cephalohematoma
=# 3aput succeda&eum is &ormal a&d will resolve i& 24 hours
7# Cesa'ean (eli)e'!
1# ?elivery of the fetus usually throu"h a tra&s-abdomi&al, low-se"me&t i&cisio& of the uterus
2# +reoperative
a# !f pla&&ed, prepare the mother a&d part&er
b# !f a& emer"e&cy, Huic'ly e1plai& the &eed a&d procedure to the mother a&d part&er
c# )btai& i&formed co&se&t
d# (a'e sure that the preoperative dia"&ostic tests are do&e, i&cludi&" the /h factor
e# +repare to i&sert a& !@ li&e a&d a 8oley catheter
f# +repare the abdome& as prescribed
"# (o&itor the mother a&d fetus co&ti&uously for si"&s of labor
h# +rovide emotio&al support
i# 6dmi&ister preoperative medicatio&s as prescribed
3# +ostoperative
a# (o&itor vital si"&s
b# +rovide pai& relief
c# .&coura"e tur&i&", cou"hi&", a&d deep breathi&"
d# .&coura"e ambulatio&
e# (o&itor for si"&s of i&fectio& a&d bleedi&"
f# -ur&i&" a&d pai& o& uri&atio& may i&dicate a bladder i&fectio&
"# 6 te&der uterus a&d foul-smelli&" lochia may i&dicate e&dometritis
h# 6 productive cou"h or chills may i&dicate
3BA
p&eumo&ia
COM"LICATIONS O* LA1OR AND DELI;ER=
"'ete' Labo'
+reterm labor is labor that be"i&s after 2B wee's "estatio& a&d before 3$ wee's "estatio&#
)btai& thorou"h obstetric
history5ow bac' pai&.0!)5)4F
)btai& specime& for 3-3 & ,/6
?etermi&e freHue&cy, duratio& &
i&te&sity of uteri&e co&tractio&s
?etermi&e cervical dilatatio&s a&d
effaceme&t
6ssess status of membra&es a&d
bloody show
.valuate fetus for distress, si2e
a&d maturity
Suprapubic pressure
@a"i&al pressure
/hythmic uteri&e co&tractio&s :2
uteri&e co&tractio&s lasti&" 3B
seco&ds withi& 15 mi&utes;
3ervical dilatatio& Y4 cm &
effaceme&t 5BC or less
.1pulsio& of cervical mucus plus
-loody dhow
S!4*S /SF(+0)(S 6SS.SS(.*0
+/)(
(6*64.(.*0+erform measures to ma&a"e or
stop +reterm labor(6*64.(.*0
"ROM :"'eatu'e Ru&tu'e of Meb'ane+
- Spo&ta&eous rupture of am&iotic membra&es prior to
o&set of labor, maybe preterm :before 3= wee's
"estatio&; or term
6SS.SS(.*0
+lace o& 3-/ i& side-lyi&" positio&
+repare fro possible ultrasou&d, am&ioce&tesis,
tocolytic a&d steroid therapy
6dmi&ister meds as prescribed
6ssess S/. such as hypote&sio&, dysp&ea, chest
pai& a&d 87/ e1ceedi&" 1=B b#p#m#
3a
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i
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!&itial Si"& 3ord +rolapse<
*)0." %irst discovered 6hen there is varia0le decelerated ,attern
87/ patter& variable< ?eceleratio&s with co&tractio&s or betwee&
co&tractio& or fetal bradycardia prese&t
+ersiste&t &o& reassuri&" fetal heart rate > fetal distress
6trophy of the umbilical cord & cord protrudi&" from va"i&a
3ord may be palpated i& cervi1/va"i&a
/efle1 co&strictio& whe& cord is e1posed to air
312
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313
u
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a
3o&firmatory 0est5ate Si"& 6m&iotomy< /upture of (embra&es
F1 7aternal A
(etal )n%ection -
#ausing
co+,ression o% the
cord and
co+,ro+ising %etal
circulation-est
(aor Sur"ery
)07./S< +rematurity,
7ypo1ia, (eco&ium
aspiratio&,8etal death if
delayed or u&dia"&osed
Cesarian Section if the cer#i@ incompletely dilated.
%ast #a*inal deli#ery )ith forceps
7istory of the
?isease8etal
&utrie&ts
supply7epari& !@
-est ?ru".ter&al
.lectro&ic 8etal
7eart /ate
mo&itori&"-est
+ositio& ?isease
3omplicatio&
3ompressio& of the
umbilical cord
0o co&trol i&travascular
coa"ulatio& i& the
pulmo&ary circulatio&
*ature of the
dru"
)1y"e& with face-
mas'#
Sterile ha&d "love
.rendelen0erg<s ,osition or Knee #hest ,osition -6hich causes the
,resenting ,art to %all 0ac4 %ro+ the cord.
0ur& side to side -7elps may be elevated to shift to fetal prese&ti&"
toward diaphra"m#
H="ERTONIC LA1OR
"ATTERNS :"'ia'!
ine'tia+H="OTONIC LA1OR
"ATTERNS :Secon(a'!
8luid volume deficit related
to active hemorrha"e
6ltered tissue perfusio&
related to mater&al vital
*ur
si&"
!&te
rve&
314
ine'tia+*ursi&"
?ia"&osis-edside
eHuipme&t
(Pillitteri5 7aternal and #hild
Nursing5 ,.2::9
(Pillitteri5 7aternal and #hild
Nursing5 ,.3I@-3IJ9
*. D!stocia
G.
7# - ?ifficult,
pai&ful, ab&ormal pro"ress of
labor of more tha& 24 hours
!#
1# +owers/ uteri&e i&ertia/
co&tractio&
2#
3#
or"a& a&d fetal related to
hypovolemia
/is' for i&fectio& related
traumati2e tissue
tio&
7anage+ent"N!S)NG
)N.EVEN.)&NPredis,osing
(actors"#A!SESEarl/ analgesia&$/tocin and
a+nionit/.EA.7EN.est and
sedation&##!EN#EN&.E" .he nurse<s F1
,riorit/ action to a ,rola,se cord is to assess the %etal
heart rate. A ,rola,sed cord interru,ts the o$/gen
and nutrient %lo6 to the %etus. )% the %etus doesn<t
receive adeDuate o$/gen5 h/,o$ia develo,s5 6hich
can lead to central nervous s/ste+ da+age in the
%etus.
1# (o&itor clie&t a&d fetus closely
2# +ossibly admi&ister tocolytic a"e&ts
3# +repare for emer"e&cy birth
1# (ultiparity
2# 7istory of rapid labor
3# +remature or small fetus
4# 5ar"e bo&y pelvis
5#
6# /is's<
1# +eri&eal laceratio&s & 7emorrha"e
A. 6hen deli#erin* the neonate3 you should
deli#er the head bet)een contractions. "his
)ill pre#ent the head from bein* deli#ered
too suddenly3 thuds pre#entin* a possible
tearin* of the perineum.
E.
4# 3# 8etal 3erebral trauma
4# +assa"eway
a# 3o&tracted pelvis
b# ,&favorable pelvic shapes
c#
d# (a&a"eme&t<
i# .valuate pelvic diameters
ii# 3o&ti&ue labor with careful mo&itori&"
iii# +erform assisted va"i&al or caesarea&
5ate&t phase of labor
315
delivery
iv#
5# +syche
a# 8ear, a&1iety ad te&sio& i&crease stress
a&d decrease uteri&e co&tractility
b# Stress i&terferes with the clie&ts ability
with her co&tractio&s
c# Stress i&crease fati"ue
d#
e# (a&a"eme&t<
i# (o&itor clie&ts psycholo"ic respo&se to
labor
ii# ?etermi&es clie&ts level of stress
iii# +rovide support
iv# .&coura"ed rela1atio&
).
)i.
vii#
)iii. D. Infection
i,.
@. "he infant is at ris8 to de#elop
thrush if the pre*nant )oman has
monillial infection at the time of
#a*inal deli#ery
,i.
,ii.
,iii.
1iv#
1v#
1vi#
1vii#
1viii#
1i1# 3lamydia
4o&orrhea
Syphilis 6!?S
0)/37
11#
11i#
11ii#
11iii#
11iv#
,,). ACGUIRED
IMMUNODE*ICIENC=
S=NDROME :AIDS+
a# 0ra&smissio&
6# 6cross the place&tal barrier
-# ?uri&" the process of labor a&d delivery
3# @ia breast mil'
-7!@ ca& cross some membra&es such as the place&tal
barrier, the blood-brai& barrier, va"i&al mucosa, a&d
:i& the &eo&ate; the walls of the "astroi&testi&al tract
316
Infection
-+re&atal tra&smissio& from i&fected mother to fetus or
&ewbor& via tra&splace&tal tra&smissio&, via
co&tami&atio& with mater&al blood duri&" birth, or
throu"h breast mil'
b# *ursi&" (a&a"eme&t
6void procedures that i&crease the ris' of pre&atal
tra&smissio&, such as am&ioce&tesis a&d fetal scalp
sampli&"
Note that i% the %etus has not 0een e$,osed to *)V in
utero5 the highest ris4 e$ists during deliver/ through
the 0irth canal
*ever use scalp electrodes
6void episiotomy to decrease the amou&t of mater&al
blood i& a&d arou&d the birth ca&al
+romptly remove the &eo&ate from the motherIs blood
followi&" delivery
*)0.< *)V has 0een %ound to 0e
trans+itted through the 0reast +il4 %ro+ +other
to 0a0/. .here%ore5 0reast %eeding isn<t
reco++ended %or a +other 6ho is *)V-,ositive.
1hile trans+ission rates o% *)V in%ection %ro+
+other to in%ant range %ro+ 2:K to I3K5
,ro%essionals esti+ate the actual trans+ission rate
at a0out B:K to 3:K. .he A)DS virus is ,assed
trans,lacentall/5 so cesarean deliver/ 6ill not
,revent in%ection o% the neonate. )n o,tions 25
trans+ission %ro+ +other to %etusVchild can occur
trans,lacentall/ throughout ,regnanc/5 trough
contact 6ith the +other<s 0lood and vaginal
secretions at deliver/ and through ingestion o%
0rea4 +il4. )n the o,tion B5 a ne60orn can 0e
s/+,to+-%ree at 0irth and still develo, A)DS. A
true diagnostic o% *)V in%ection in neonates
cannot actuall/ 0e +ade until around 13 +onths
o% age.
G# "'eci&itate (eli)e'!
6SS.SS(.*0
-owel or bladder diste&tio&
(ultiple "estatio&
5ar"e fetus
7ydram&ios
4ra&dmultiparity
3esarea& sectio& if labor does &ot resume
8etal mo&itori&"
.he ,ri+ar/ goal 6ith a ,rola,sed o% the u+0ilical
cord is to re+ove the ,ressure %ro+ the cord.
#hanging the +aternal ,osition is the %irst
intervention. Acce,ta0le ,ositions include 4nee-
chest5 side-l/ing and elevation o% the hi,s. .he nurse
+a/ also ,er%or+ a vaginal e$a+ination and atte+,t
to ,ush the ,resenting ,art o%% the cord.
Ad+inistering the o$/gen 0ene%its the %etus onl/ i%
circulation through the cord has 0een reesta0lished.
Start or mai&tai& a& !@ as prescribed# ,se of
lar"e-"au"e catheter whe& starti&" the !@ for
blood a&d lar"e Hua&tities of fluid i&ta'e#
6dmi&ister o1y"e& by face >mas' to provide hi"h
o1y"e& co&ce&tratio& at = >1B5/mi&#
!&struct patie&t to clea&se from the fro&t to the
bac'#
.1plai& the importa&ce of ha&d washi&" before
a&d after peri&eal care#
)07./ (6*64.(.*0<
/epositio& clie&t to tre&dele&bur" or '&ee-
chest positio&
)1y"e&
+ush prese&ti&" part upward
6pply moiste&ed sterile towels
?elivery as soo& as possible
A
32A
sco'e
3. Note
c#a'acte'istics of c'!
.. Monito' fo'
nasal fla'in$D
$'untin$D
'et'actionsD
abno'al
'es&i'ations
0. Obtain )ital
si$ns
4. Obse')e
ne<bo'n fo'
si$ns of
#!&ot#e'ia
o'
#!&e't#e'ia
5. Assess fo' $'oss
anoalies
-. I&leentation
%. Suction
out#D t#en na'esD <it#
bulb s!'in$e
-. D'! ne<bo'n
an( stiulate c'!in$ b!
'ubbin$
3. Maintain
te&e'atu'e
stabilit!S <'a&
ne<bo'n in
<a' blan2ets
an( &lace a
stoc2inette ca&
on ne<bo'nOs
#ea(
NOTEA
Te&e'atu'e ta2in$
.he 0est site
6ithout
co+,lications
is the ta4ing it
in a$illa. )t is
not advisa0le to
,ut it in the
+outh5 anus or
ear since all o%
the+ are
sensitive.
.. Hee& ne<bo'n
33B
<it# ot#e' to
facilitate
bon(in$
0. "lace
ne<bo'n at
ot#e'Os
b'east if
b'eastfee(in$
is &lanne(D o'
&lace on
ot#e'Os
ab(oen
4. "lace
ne<bo'n in <a'e'
5. "osition
ne<bo'n on
si(e o'
ab(oen o' in
o(ifie(
T'en(elenbu'$
&osition to
facilitate
('aina$e of
ucus
6. Ensu'e
ne<bo'nOs &'o&e'
i(entification
7. *oot&'int
ne<bo'n an(
fin$e'&'int
ot#e' on
i(entification
s#eetD &e'
a$enc! &olicies
an( &'oce(u'es
%8. "lace
atc#in$ i(entification
b'acelets on ot#e' an(
ne<bo'n
NOTEA Con)ectionD
Con(uctionD Ra(iation
an( E)a&o'ation
Eva,oration occurs 6hen
6et sur%aces such as
neonate<s s4in are e$,osed
to air.
#onduction o% heat a6a/
%ro+ the 0od/ +a/ occur
6hen the neonate co+es
in direct contact 6ith cold
331
sur%aces such as scale or
cold stethosco,e.
adiation is the trans%er o
heat to cooler o0Gects that
are not in direct contact
6ith the neonate.
#onvection- 4ee,ing a6a/
the neonate %ro+ the air
conditioning or cooling
ducts ,revents heat loss
3. ;ital si$ns
6+46/ 3/!0./!6
6+46/ S3)/.
Symptoms of
depressio& plus
delusio&s
6uditory
halluci&atio&s
7yperactivity
O,!tocin
Anal$esics
Maintain #!$iene
Sei9fo<le's
&ositions
;ital si$ns
Ea'l! abulations
Assess loc#ia
Bright red 0lood is a
nor+al lochial
%inding in the %irst
2B hours a%ter
deliver/. Lochia
should never
contain large clots5
tissue %rag+ents5 or
+e+0ranes. A %oul
odor +a/ signal
in%ection5 as +a/
a0sence o% lochia.
*o respo&se4rimace
@i"orous cry7.6/0
/60.
6bse&t 5ess tha& 1BB b#p#m# )ver 1BB b#p#m#
(,S35. 0)*./.85.O
!//!06-!5!0F
5imp Some fle1io& 6ctively moves
/.S+!/60)/F .88)/0 6bse&t Slow, irre"ular 4ood cry
332
"he components of Ap*ar scorin* system are tone3 color3 irritability3 respiration and heart rate.
1# +erform a&d record the 6p"ar score at 1 mi&ute a&d at 5 mi&utes
2# !f the score is less tha& $ at 5 mi&utes, the 6p"ar score should be performed at 1B mi&utes
3# 6ssess each of five items to be scored, a&d assi"& value of C :very poor; to 2 :e1celle&t; for each item
4# 6dd the poi&ts to determi&e the &ewbor&Es total score
a# 6 score of $ to 1B i&dicates a health
-in(icates t#at t#e ne<bo'n is (oin$ <ell.
b# 6 score of 3 to 6 is co&sidered moderately depressed
c# 6 score of B to 2 is severely depressed
- in(icates t#at t#e ne<bo'n nee(s assistance.
1# 7eart rate< 1BB to 1$B beats per mi&ute :apical;9 assess for a full mi&ute because of irre"ularities
afterbirth
2# /espiratio&s< 3B to =B breaths per mi&ute9 assess or a full mi&ute
3# 61illary temperature< A6#= to AA^ 8
4# -lood pressure< $3/55 mm 7"
.. 1o(! easu'eents
1# 5e&"th< 45 to 55 cm :1= to 22 i&ches;
2# %ei"ht< 25BB to 43BB " :5#5 to A#5 pou&ds;
3# 7ead circumfere&ce< 33 to 35#5 cm :13 to 14 i&ches;
4# 3hest circumfere&ce< 3B to 33 cm :12 to 13 i&ches; a&d should be eHual to or 2 to 3 cm less tha& the head
circumfere&ce
*)0.< Neonates +ead #ersus Chest circumference
At birth3 the neonates head circumference is about Acm LA-$ "+AN "+$ C+$S"
CICUM%$$NC$. "he A#era*e +ead circumference is 9E .9J inches 0EE.EF cm7 3 a#era*e Chest
circumference is 9A.F to 9J inches 0 E9.EF cm7
1 . Hea( to Toe Ne<bo'n Assessent
333
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
,ri&e prese&t i& the bladder at birth but *- may &ot void doe 1
st
12-24 hours
5ater patter& is 6-1B voidi&"s/ day > i&dicative of sufficie&t fluid i&ta'e
,ri&e is pale a&d straw colored > i&itial voidi&"s may leave bric'-red spots o&
diaper : d/t passa"e of uric acid crystals i& uri&e;
!&fa&t u&able to co&ce&trate uri&e for the 1
st
3 mo&ths
334
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
!((60,/. 36/?!63
S+7!*30./ > may allow reflu1 of
food, burped, /.4,/4!060.-
placed *- ri"ht side after feedi&"
*ewbor& ca&Et move food from lips
to phary&1# !&sert &ipple well to
mouth
8..?!*4 +600./S vary
- *ewbor&s may &urse vi"orously
immediately afterbirth or may &eed
as lo&" as several days to suc'
effectively
- +rovide support a&d e&coura"eme&t
to &ew mothers duri&" this time as
i&fa&t feedi&" is very emotio&al
doe most mothers
NO"$1 ,istin*uishin* Neonatal
&omitin* from e*ur*itation
&omitin* is usually sour3 loo8s li8e
curdled mil8 due to +CL3 )ith a sour
odor3 )hile re*ur*itation has no sour
odor or curdlin* of mil83 or occurs
durin* or immediately after feedin*.
!(+)/06*0 3)*S!?./60!)*S<
(reastfeedin* can usually
be*in immediately after birthH
bottle.fed ne)borns may be
offered fe) milliliters of
sterile )ater or FB de@trose 9
to J hours after birth prior to
a feedin* )ith formula
335
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
5iver respo&sible for cha&"i&" 7"b i&to co&u"ated bilirubi&, which is further
cha&"ed i&to co&u"ated :water soluble; bilirubi& that ca& be e1creted
.1cess u&co&u"ated bilirubi& ca& permeate the sclera a&d the s'i&, "ivi&" a
au&diced or yellow appeara&ce to these tissues
HEAT "RODUCTION i& &ewbor& accomplished by<
a# (etabolism of R -/)%* 860S
- 6 special structure i& *- is a source of heat
- !&creased metabolic rate a&d activity
61illary temperature< A6#= to AA8
*ewbor& ca&Et shiver as a& adult does to release heat
*ewbor&s are u&able to mai&tai& a stable body temperature because they have a&
immature vasomotor ce&ter, a&d u&able to shiver to i&crease body heat#
*-Es body temperature drops Huic'ly after birth > after stress occurs
easily
-ody stabili2es temperature i& =-1B hours if u&stressed
Cold stress increases oA consumption I may lead to metabolic acidosis
and respiratory distress
N( de#elops o)n antibodies durin* 9
st
E months but at ris8 for infection durin* the
first : )ee8s
6bility to develop a&tibodies develops seHue&tially
-irth wei"htJ25BB-4BB "rams :5 lbs# =o2# > = lbs# 13 o2#;
336
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
*ose breathers for first few mo&ths of life
33$
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
Short a&d wea' with deep fold of s'i&
3haracteri2ed by cyli&drical thora1 a&d fle1ible ribs
*)0.<
appears circular si&ce a&teroposterior a&d lateral diameters are about eHual
/espiratio&s appear diaphra"matic
*ipples promi&e&t a&d ofte& edematous
7il4/ secretion (6itchXs +il49 co++on ( e%%ect o% estrogen9
33=
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
33A
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
34B
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
341
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
342
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
343
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
344
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
345
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
346
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
Should be strai"ht a&d flat
6&us should be pate&t without a&y fissure
?impli&" at the base is associated with spi&a bifida
A degree o% h/,otonicit/ or h/,ertonicit/ is indicative o% central nervous s/ste+ (#NS
da+age
Assess+ent %or
Eaundice
.he F1
techniDue is to
0lanch the s4in
over the 0on/
,ro+inence such
as the %orehead5
chest or ti, o%
the nose.
NOTEA
starts at the head
first3 spreads to
the chest3 then the
abdomen3 then the
arms and le*s3
follo)ed by the
hands and feet3
)hich are the last
to be ?aundiced.
!aundice in the
first AJ hours
after the birth is
a cause for
concern that
re4uires further
assess+ent.
C.GESTATIONAL
ASSESSMENT
+6/6(.0./
*,/S!*4 630!)*
34$
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
Possi0le causes
o% earl/
Gaundice are
0lood
inco+,ati0ilit/5
o$/tocin
induction5 and
severe
he+ol/tic
,rocess
Acrocyanosis of
the hands and
feet is normal3
resultin* from
slu**ish
peripheral
circulation
Mon*olian Spots
-ary3 blue or
blac8 mar8s that
are fre4uently
found on the
sacral area3
buttoc8s3 arms
shoulders or
other areas.
+arle4uins Si*n
Occurs on one
side of the body
turns deep red
color. It occurs
)hen blood
#essels on one
34=
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
side constrict3
)hile those on
the other side of
the body dilate.
Acrocyanosis
#ersus Central
Cyanosis
Acrocyanosis
in#ol#es the
e@tremities of the
neonate3 for
e@ample bluish
hands and feet
due to neonates
bein* cold or
poor perfusion of
the blood to the
periphery of the
body.
6hile central
cyanosis3 )hich
in#ol#es the lips3
ton*ue and trun8
indicatin*
+5PO'IA )hich
needs further
assessment by the
nurse.
.
E,stein<s ,earls
are small3 )hite
cysts on the hard
palate or *ums of
34A
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
the ne)born.
"hey are nor
abnormal and
)ill disappear
shortly after
birth.
7ilia are
bloc8ed
sebaceous
*lands located
on the chin and
the nose of the
infant.
+eman*iomas >
&ascular "umors
Ne#i flammeus or
port )ine stains
&$NI'
CAS$OASA
Should not be
remo#ed by oil or
hand lotion3
because it is a
protecti#e layer
of the neonate
after birth3 and it
disappears after
birth 0 pa*e 9TT
lippincot7 Ne#er
remo#e it )ith
alcohol or cotton
balls3 unless
35B
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
meconium
s8inned.
*)0.<
@er&i1 3aseosa
.rythema
to1icum
&eo&aturum
0ela&"iectasia
+ort wi&e stai&
:&evus flamus;
Strawberry
hema&"ioma
+eman*ioma is
beni*n #ascular
tumor that may
be present on the
ne)born
8i"ure 24
7ema&"ioma
8i"ure 25
.rythema
to1icum
&eo&aturum a&d
(ilia
8old the pi&&a
:auricle; forward
Pinna recoils 0sprin*s
bac87
Pinna opens slo)ly or stays folded
in #ery premature infants
351
,(-!5!365 @.!* a&d ?,30,S @.*)S,S co&strict after cord id clamped
?,30,S 6/0./!)S,S co&strict with establishme&t of respiratory fu&ctio&
8)/6(.* )@65. closes fu&ctio&ally as respiratio&s established, but
a&atomic or perma&e&t closure may ta'e several mo&ths
7.6/0 /60. avera"es 14B b#p#m#
-+ $3/55 mm7"
+./!+7./65 3!/3,560!)* acrocya&osis withi& 24 hours
/-3 hi"h immediately after birth9 falls after 1
st
wee'
6-S.*3./ *)/(65 85)/6 !*0.S0!*. @itami& L
(easure it E mm Less than E mm
)bserve Labia ma?ora co#er
labia minora
Labia minora are more prominentH
#a*inal openin* can be seen
)bserve $@tend A>E of the )ay
from the toes to the heel
Soles are smoother3 creases e@tend
less than A>E of the )ay from the
toes to the heel
D.NE?1ORN RE*LE@ES
0he rooti&" refle1 is elicited by stro'i&" the &eo&ateIs chee' or stro'i&" &ear the cor&er of the &eo&ateIs mouth#
0he &eo&ate tur&s the head i& the directio& of the stro'i&", loo'i&" for food# 0his refle1 disappears by 6 wee's#
)ther optio&s refer to other refle1es see& i& &eo&ates< 0he palmar "rasp refle1 is elicited by placi&" a& obect i&
the palm of a &eo&ate9 the &eo&ateIs fi&"ers close arou&d it# 0his refle1 disappears betwee& a"es 6 a&d A
mo&ths# 0he -abi&s'i refle1 is elicited by stro'i&" the &eo&ateIs foot, o& the side of the sole, from the heel
toward the toes# 6 &eo&ate will fa& his toes, produci&" a positive -abi&s'i si"&, u&til about a"e 3 mo&ths# 0he
suc'i&" refle1 is see& whe& the &eo&ateIs lips are touched a&d lasts for about 6 mo&ths#
/ooti&" a&d suc'i&"
refle1 usually
disappears after 3-4
mo&ths but may
persists for up to 1
year+65(6/
4/6S+ /.85.O
*ewbor&Es fi&"ers curl arou&d the e1ami&erEs fi&"ers a&d the &ewbor&Es toes curl
dow&ward#
+almar respo&se lesse&s withi& 3-4 mo&ths
+almar respo&se lesse&s withi& = mo&ths
-e"i&&i&
" at the
heel of
the foot,
"e&tly
Symmetric & bilateral abductio& & e1te&sio& of arms a&d ha&ds
0humb & forefi&"er form a 3
R.(-/63.S refle1
+rese&t at birth, complete respo&se may occur up to = wee's
6 persiste&t respo&se lasti&" more tha& 6 mo&ths may i&dicate the occurre&ce of
352
stro'e
upward
alo&" the
lateral
aspect of
the sole9
the& the
e1ami&er
moves
the
fi&"ers
alo&" the
ball of
the
foot()/
)
/.85.O
/))0!*
4
/.85.O
.he ne60orn<s
toes
h/,ere$tend
6hile the 0ig
toe dorsi%le$es
e%le$
disa,,ears
a%ter the
ne60orn is 1
/ear old
6bse&ce of this
refle1 i&dicates
the &eed for a
&eurolo"ical
e1ami&atio&
brai& dama"e duri&" pre"&a&cy
A normal refle@ in a youn* infant caused by a sudden loud noise. It results in dra)in*
up the le*s3 an embracin* position of the arms3 and usually a short cry.
8i"ure 26 (oro /efle1 or .mbrace /efle1
%hile the
&ewbor&
is falli&"
asleep or
sleepi&",
"e&tly
a&d
Huic'ly
tur& the
head to
o&e
sideS0.+
+!*4 )/
0he &ewbor& simulates wal'i&", alter&ately fle1i&" a&d e1te&di&"
the feet
0he refle1 is usually prese&t 3-4 mo&ths
353
%65L!*
4
/.85.O
-6-!*S
L!E S!4*
6s the
&ewbor&
faces the left
side, the left
arm & le"
e1te&d
outward
while the
ri"ht arm &
le" fle1
%he& the
head is
tur&ed to the
ri"ht side,
the ri"ht arm
& le" e1te&d
outward
while the left
arm & le"
fle1
,sually
disappears
withi& 3-4
mo&ths
3/6%5!*40)*!
3 *.3L
/.85.O
a# +lace the &ewbor& o& the abdome&
b# 0he &ewbor& be"i&s ma'i&" crawli&" moveme&ts with the arms a&d le"s
c# .he re%le$ usuall/ disa,,ears a%ter a0out H 6ee4s
E. 1ASIC TEACHING NEEDS O* NE? "ARENTS
+/
.
0.
/
(
!*
86
*
3)/? 36/. 3lea&se the cord with alcohol a&d sometimes triple dye o&ce a day
Leep the area clea& a&d dry
Leep the &ewbor&Es diaper below the cord to preve&t irritatio&
Si"&s of i&fectio&< red&ess, drai&a"e, swelli&", odor
*otify physicia& for si"&s of i&fectio&
*)0.<
Note any bleedin* or draina*e from the cord
"riple dye may be applied for initial cord care because it
minimi2es microor*anisms and promotes dryin*H use a cotton.
354
0
-
)
*
?!
*
4
.&
co
ur
a"
e
pa
re
&t
to
tal
'
to,
ho
ld,
a&
d
si&
"
to
i&f
a&t
)b
ser
ve
for
ble
edi
&"
,
fir
st
uri
&at
io
&
6
&e
o&
ate
tipped applicator to paint the dye3 one time3 on the cord on 9 inch
of surroundin* s8in
Application of KCB isopropyl alcohol to the cord )ith each
diaper chan*e and at least t)o r three times a day to minimi2e
microor*anisms and promote dryin*.
*)0.< "he s8in is surrounded )ith alcohol )hich promotes dryin* and
cleans the area. "he umbilical cord dries and falls off about 9J days.
Pero@ide and lanolin promote moisture3 )hich can inhibit dryin* and
allo) *ro)th of bacteria. 6ater doesn/t promote dryin*.
It is best to care for the neonate/s umbilical cord area by cleanin* it )ith
cotton pled*ets moistened )ith alcohol. "he alcohol promotes dryin* and
helps decrease the ris8 of infection. An antibiotic ointment maybe used
instead of alcohol3 because there are a lot of bacteria )hich is resistant
a*ainst some bacteria. Other a*ents such as )ipes3 sterile )ater and soap
< )ater are not as effecti#e as alcohol.
355
bo
r&
be
for
e
3=
we
e'
s
a"
e
of
"e
sta
tio
&
8i"
ure
2$
+re
ma
tur
e
i&f
a&t
s
sol
e
cre
ase
s,
ear
lob
e
a&d
pre
ma
tur
e
fe
ma
le
"e&
ital
ia
356
"R
E
TE
R
M
IN
*A
NT
?efi&itio&
+romo
tes
s'i&-
to-s'i&
co&tact
betwee
&
pare&t
a&d
i&fa&t
8eedi&
"s are
opport
u&ities
for
pare&t-
i&fa&t
bo&di&
"
*otify
physici
a& for
si"&s
of
i&fecti
o&
N
&.E"
Sense
o%
.ouch
35$
.h
e +ost
highl/
develo
,ed
sense
at
0irth
that is
6h/5
neona
tes
res,on
ds 6ell
to
touch.
6ppl
y
diape
r
loosel
y to
preve
&t
irritat
io&
*otif
y
physi
cia&
for
si"&s
of
i&fect
io&
3!/3,(
3!S!)*
36/.
Sy&o&ym
Lo) birth )ei*ht
0Mosby/s Comprehensi#e e#ie) of Nursin* for NCL$'.N pa*e A9F7
3o&tributi&" factors 5ow socioeco&omic level
+oor &utritio&al status
5ac' of pre &atal care
(ultiple pre"&a&cy
+rior previous early birth
/ace :&o& whites have a hi"her i&cide&ce of prematurity tha&
whites;
3i"arette smo'i&"
0he a"e of the mother : the hi"hest i&cide&ce is i& motherEs
you&"er tha& a"e 2B#;
35=
)rder of birth : early termi&atio& is hi"hest i& first pre"&a&cies
a&d i& those beyo&d the forth ;
3losely spaced pre"&a&cies
6b&ormalities of the reproductive system such as i&trauteri&e
septum
!&fectio&s : specially uri&ary tract i&fectio&s;
)bstetric complicatio&s such as premature rupture of membra&es
or premature separatio& of the place&ta
.arly i&ductio& of labor
.lective cesaria& birth
3ardi&al si"&s 6ppears small a&d u&derdeveloped
0he head is disproportio&ately lar"e : 3 cm or more "reater tha&
chest si2e;
S'i& is thi& with visible blood vessel a&d mi&imal subcuta&eous
fat pads
@er&i1 caseosa is abse&t
-oth a&terior a&d posterior fo&ta&elles are small
/e
su
sci
tat
io
&
*
)
0
.<
res
us
cit
ati
on
0e
co
+e
s
i+
,o
rta
nt
%or
in%
an
t
6h
o
%ai
ls
to
ta4
e
6b&ormal laboratory values ?ecreased /-3Es
?ecreased serum "lucose
!&creased co&ce&tratio& of i&direct bilirubi&
?ecreased serum albumi&
*)0.< .he nor+al range o% urine out,ut %or a ,reter+
0a0/ is 1 to 2+l?4g?da/. .he nor+al s,eci%ic gravit/ %or a
,reter+ 0a0/ is 1.:2:. .he nor+al range %or 0lood glucose
level in a ,reter+ 0a0/ is B: to H: +g?dl.
35A
%ir
st
0r
eat
h
or
di%
%ic
ult
/
+a
int
ai
ni
ng
ad
eD
ua
te
res
,ir
ato
r/
+o
ve
+e
nts
on
his
o6
n.
Su
cti
o&i
&"
*)
0.
<
all
o6
s
re
+o
vin
g
+
uc
us
an
d
,r
ev
ent
s
as
36B
,ir
ati
on
o%
an
/
+
uc
us
an
d
a+
ni
oti
c
%lu
id
,r
ese
nt
in
the
+o
ut
h
an
d
no
se
o%
the
ne
60
or
n
to
est
a0l
ish
cle
ar
air
6a
/.
!&t
uba
tio
&s
*)
0.<
he
ad
o%
the
in%
361
ant
in
ne
utr
al
,os
itio
n
6it
h
to
6el
un
der
sh
oul
der
.
-est
procedure
-est positio& +ositio&i&" the i&fa&t o& the bac' with the head of the mattress
elevated appro1imately 15 de"rees to allow abdomi&al co&te&ts to
fall away from the diaphra"m affordi&" optimal breathi&" space#
-est positio& for suctio&i&"<
!&fa&t o& the bac' a&d slide a folded towel or pad u&der shoulders
to rise, head is i& &eutral positio&#
3omplicatio&s 6&emia of prematurity
7yperbilirubi&emia/ 'er&icterus
+ersiste&t pate&t ductus arteriosus
+erive&tricular / i&trave&tricular hemorrha"e
/espiratory distress sy&drome
etino,ath/ o% ,re+aturit/
etrolental fibroplasias are a complication that occurs if the infant is
o#ere@posed to hi*h o@y*en le#els.
Necroti8ing enterocolitis
7ost
severe
%or+
o%
s,ina
0i%ida .
( ,.
@J@5
.e$t0o
o4 o%
Basic
Nursin
g
Li,,in
cott H
th
ed.9&n
e o% the
"'ete' si3e
la'!n$osco&e
ET tube
Suction cat#ete' <it#
s!nt#etic su'factant
Isolettes :incubato'+
D'u$ stu(!
362
+enin
ges
(the
S,inal
cord
coverin
g9
,rotru
des or
herniat
ed
throug
h
o,enin
g in
verte0r
al
colu+
n. (,.
@J@5
.e$t0o
o4 o%
Basic
Nursin
g
Li,,in
cott H
th
ed.9Des
c'i&tio
n)s an
o,enin
g in
the
verte0r
al
colu+
n 6ith
no
a,,are
nt
reason.
( ,.
@J@5
.e$t0o
o4 o%
Basic
Nursin
g
Li,,in
cott H
th
ed.9S,i
na
0i%ida
occulta
7enin
gocele
363
7/elo
+enin
gocele
./,esS
,ina
0i%ida
occulta
S/non/
+sS,in
al
D/sra,
hia
e%ers
to
+al%or
+ation
o%
s,ine
in
6hich
the
,osteri
or
,ortion
o% the
la+ina
e o% the
verte0r
ae %ails
to
close.N
ursing
interve
ntions1
.
Nursin
g
diagno
ses1.
)ne%%ec
tive
air6a/
0reathi
ng
Positio
ning
the
in%ant
on the
0ac4
6ith
the
head
o% the
+attres
s
364
elevate
d
a,,ro$
i+atel/
13
degree
s to
allo6
a0do+i
nal
content
sA0nor
+al
la0orat
or/
values)
ncreas
ed total
no. o%
B#<s
#lassic
signs)n
trauter
ine
6eight
loss5
deh/dr
ations
and
chroni
c
h/,o$i
a Wold
+an
%aces<
Nursin
g
interve
ntion.
he
nurse<s
%irst
,riorit/
in
,re,ari
ng a
sa%e
enviro
n+ent
%or a
,reter
+
ne60or
n 6ith
lo6
A,gar
365
scores
is to
,re,ar
e
res,ira
tor/
resusci
tation
eDui,+
ent.
Air6a/
+ainte
nance
is the
%irst
,riorit/
.Nursi
ng
diagno
sis)+,
aired
gas
e$chan
ge
related
to
i++at
ure
,ul+o
nar/
%unctio
ning
"'ot'
usion
of t#e
s&inal
co'(
&'ot'u
(es
t#'ou$
# t#e
bac2.
Sacs
a'e
co)e'e
( b!
t#in
eb'
ane &
ne')e
a'e
e,&ose
(
Neu'o
lo$ical
366
(eficits
a'e
e)i(ent
Menin
$es o'
&'otect
i)e
co)e'i
n$
a'oun(
t#e
s&inal
co'(
#as
&us#e(
out
t#'ou$
# t#e
o&enin
$ in
t#e
)e'teb
'ae in
a sac.
S&inal
co'(
intact
Neu'o
lo$ical
(eficit
a'e
usuall!
NOT
"RES
ENT
Can
be
'e&ai'e
( </
little o'
no
(aa$
e to t#e
ne')e
&at#<
a!s.
7ost
co++o
n site
o%
inGur/
U
lu+0os
acral
area
36$
( 7os0
/<s
#o+,r
ehensi
ve
revie6
o%
Nursin
g %or
N#LE
>-N
,. 22H9
: enin$o!el
ocele+
Menin$oc
ele
M!eloe
nin$ocele
o
O
A.
RES"IR
ATOR=
DISTRE
SS
S=NDRO
ME
9
D
9
C
9
A
9
9 N
O
T
E
"
7
or
e
36=
c
o
+
+
o
n
in
n
e
o
n
at
es
d
el
iv
er
e
d
0
/
ce
sa
re
a
n
se
ct
io
n
th
a
n
in
th
os
e
d
el
iv
er
e
d
v
a
gi
n
al
l/
.
9
9 C
O
M
M
O
36A
N
SI
G
N
S
9
!a
n
os
isD
(
!s
&
ne
aD
st
e'
n
al
a
n
(/
o'
co
st
al
'e
t'
ac
ti
o
ns
D
ta
c#
!
&
ne
aD
$'
u
nt
in
$D
a
n
(
n
as
al
fl
a'
in
$D
%l
ar
3$B
in
g
n
ar
es
5
E
$
,i
ra
to
r/
gr
u
nt
in
g
9
9 M
A
N
A
G
E
M
E
N
T
9
ai
nt
ai
n
a
&
at
en
t
ai
'
<
a!
D
&l
ac
e
t#
e
in
fa
nt
in
a
<
a'
3$1
is
ol
le
te
<i
t#
o,
!$
en
D
a
(
in
ist
e'
a
nt
ib
io
ti
cs
as
&'
es
c'
ib
e(
a
n
(
co
''
ec
t
ac
i(
os
is
9
1.
HEMOL
=TIC
DISEAS
E
9
A
9
9 COM
MON
SIGN
S
9
E
3$2
9
9
9 "RE;
ENTI
ON
INDI
RECT
COO
M1IS
TEST
9
T
9
"
9
9 RESU
LTSA
9
If
9
R
9
If
9
9 DIRE
CT
COO
M1IS
TEST
9
T
9
9 RESU
LTS
9
If
9
N
9
R
9
C.
H="E
R1IL
IRU1
3$3
INEM
IA
9
Se
9
A
9 E
)a
lu
at
io
n
is
in
(i
ca
te
(
<
#e
n
se
'u
A
o
ve
r
1
2
+
g?
d
L
in
th
e
te
r
+
n
e
6
0
or
n
9 T
#e
'a
&
!
is
3$4
ai
e(
at
&'
e)
en
ti
n
$
'e
su
lts
in
&e
'
a
ne
nt
ne
u'
ol
o$
ic
al
(
a
a$
in
$
f'
o
t#
e
(e
&
os
iti
o
n
of
bi
li'
u
bi
n
3$5
in
ce
lls
9
9
T
9
9
T
9
9
"
9
9
N
9
9
9
9
9
E,&ose as
uc# of
t#e
ne<bo'nOs
s2in as
&ossible
#over the
genital
area5 and
+onitor
genital
area %or
s4in
irritation
or
0rea4do6
n
( ,ria,is+
+a/
3$6
occur9
#over the
ne60ornXs
e/es 6ith
e/e shields
or
,atches'
+a4e sure
e/elids are
closed
6hen
shields or
,atches
are
a,,lied
e+ove
the shields
or ,atches
at least
once ,er
shi%t to
ins,ect the
e/es %or
in%ection
or
irritation
and to
allo6 e/e
contact
. Measu'e
t#e
Fuantit!
of li$#t
e)e'! 6
#ou's
Monito'
s2in
te&e'atu
'e closel!
)ncrease
%luids to
co+,ensat
e %or 6ater
loss
3$$
E$,ect
loose
green
stools and
green
urine
7onitor
the
ne60ornXs
s4in color
6ith the
%lorescent
light
turned o%%5
ever/ B to
@ hours
7onitor
the s4in
%or 0ron8e
0a0/
s/ndro+e5
a gra/ish
0ro6n
discolorati
on o% the
s4in
e,osition
ne60orn
ever/ 2
hours
R#
anti$e
ns
f'o
t#e
bab!Os
bloo(
3$=
ente'
t#e
ate'
nal
bloo(s
t'ea
Dest'
uction
of
R1Cs
t#ose
'esult
s f'o
an
anti$e
n
antibo
(!
'eacti
on
E,c#a
n$e of
fetal
an(
ate'
nal
bloo(
ta2es
&lace
&'ia
'il!
<#en
t#e
&lacen
ta
se&a'
ates at
bi't#
T#e
ot#e
'
&'o(u
ces
anti9
R#
antibo
(ies
a$ains
t t#e
3$A
fetal
bloo(
cells
Antib
o(ies
a'e
#a'l
ess to
t#e
ot#e
' but
attac#
to t#e
e'!t#'
oc!tes
in t#e
fetus
an(
cause
#eol
!sis
Sensit
i3atio
n is
'a'e
<it#
t#e
fi'st
&'e$n
anc!
AB&
inco+
,ati0il
it/ is
usuall
/ less
severe
1.
Assess
ent
%.
#!&e'
bili'u
bine
ia &
#eol
!tic
anei
3=B
a
-.
Eaund
ice
that
develo
,s
ra,idl
/ a%ter
0irth
and
0e%ore
2B
hours
(PA.
*&L
&G)#
AL
EA!N
D)#E
9
C.
I&le
enta
tion
1. A(iniste
' R#o:D+
iune
$lobulin to
t#e
ot#e'
(u'in$ t#e
fi'st 5-
#ou's
afte'
(eli)e'! if
t#e R#9
ne$ati)e
ot#e'
(eli)e's
an R#9
&ositi)e
fetus but
'eains
unsensiti3
e(
2. T#e
bab!Os
bloo( is
3=1
'e&lace(
<it# R#9
ne$ati)e
bloo( to
sto& t#e
(est'uctio
n of t#e
bab!Os 'e(
bloo(
cellsS t#e
R#9
ne$ati)e
bloo( is
'e&lace(
<it# t#e
bab!Os
o<n bloo(
$'a(uall!
2.
B. NOTEA
.he *
negative
+other
6ho has
no titer
(negative
#oo+0s<
test
results5
non
sensiti8ed9
and 6ho
has
delivered
an *
,ositive
%etus is
given an
intra
+uscular
inGection
o% anti-*
(D9
(*oGA
79.
Paternal
0lood t/,e
+ight 0e
deter+ine
d %or the
,regnant
*
negative
3=2
6o+an in
order to
hel,
deter+ine
%etal 0lood
t/,e..
3.
H. *oGA7
0loc4s
anti0od/
,roduction
0/
attaching
to %etal
*
,ositive
0lood cells
in the
+aternal
circulation
0e%ore an
i++unolo
gical
res,onse
is
initiated.
I.
@. *oGA7
+ust 0e
ad+inister
ed to
unsensiti8
ed
,ost,artu
+ 6o+en
a%ter the
0irth o%
each *
,ositive
in%ant to
,revent
,roduction
o%
anti0odies.
)% the
%ather o%
%uture
%etuses is
*
,ositive
hetero8/go
us5 there is
a 3:K
chance o%
an *
negative
3=3
in%ant' i%
he is *
,ositive
ho+o8/go
us5 all
in%ants
6ill 0e *
,ositive.
J.
1:.
11. THE
ADDICT
ED
NE?1OR
N
NOTED
*EATURESA
Short
,al,e0r
al
%issures5
*/,o,la
stic
,hiltru
+D
short5
u,turne
dnose5
*lat
i(face
T#in u&&e' li&D
Lo< nasal 0ridge5
Abno'al &ala'
c'easesD
Res&i'ato'!
(ist'ess Ta&neaD
c!anosis+D
Con$enital #ea't
(iso'(e'sD
)rrita0ilit/5
h/,ersensitivit/ to
sti+uli5 .re+ors
Poor
%eeding5
Sei3u'es
.
N&.E"
.hese
3=4
are
signs o%
*eroine
6ithdra
6al
usuall/
occurs
6ithin
2B to B@
hours o%
0irth.
.he
ne60or
n +a/
0e Gitter/
and
h/,eract
ive. .he
cr/ is
o%ten
shrill
and
,ersiste
nt 6ith
/a6ning
and
snee8ing
. .endon
re%le$es
are
increase
d5 and
7oro<s
re%le$ is
decrease
d.
NOTEA
*eroin
6ithdra6al
neonates
*igh
,itch
cr/5
increase
)#P5
h/,ogl/
ce+ia5
loud
and
lust/ cr/
NURSING
INTER;ENTI
ONA
3=5
%. 7onitor
%or
res,irator/
distress
-. "osition
ne<bo'n on
si(e to
facilitate
('aina$e of
sec'etions
3. Hee&
'esuscitatio
n
eFui&ent
at t#e
be(si(e
.. 7onitor
%or
h/,ogl/ce+
ia
0. Assess
suc2 an(
s<allo<
'efle,
4.
A(iniste'
sall
fee(in$s
an( bu'&
<ell
5. Suction
as
necessa'!
6.
Monito' I
& 8
7. 7onitor
6eight and
head
circu+%eren
ce (#hec4
%or )ncrease
)#P9
%8.
Dec'ease
en)i'onen
tal stiuli
%%. .he
use o%
narcotic
antagon
ists to
3=6
reverse
res,irat
or/
de,ressi
on in
the drug
addicted
neonate
is
contrain
dicated
0ecause
these
drugs
+a/
,reci,it
ate
acute
6ithdra
6al in
the
neonate.
NE? 1ORN
O*
DIA1ETIC
MOTHER
A. Desc'i&tion
Neonate
bo'n to an
insulin9
(e&en(ent
ot#e' o'
$estationa
l (iabetic
ot#e'
an( <it#
#i$#
inci(ence
of
con$enital
anoalies.
COM"
LIC
ATI
ON
SA
*ig
h
inci
den
3=$
ces
o%
h/,
ogl/
ce+
ia5
res,
irat
or/
dist
ress
5
h/,
ocal
ce+
ia5
and
h/,
er0i
liru
0ine
+ia
1. Assessent
7A#
&S&
7)A
A
LGA
as a
result
o%
e$cess
%at
and
gl/cog
en in
tissue
s
E(e
a o'
&uffin
ess in
t#e
face
an(
c#ee2
s
Signs
o%
h/,og
l/ce+i
a5
3==
such
as
t6itch
ing5
di%%icu
lt/ in
%eedin
g5
lethar
g/5
a,nea
5
sei8ur
es5
and
c/ano
sis
H!&e'
bili'u
bine
ia
Signs
o%
res,ir
ator/
distres
s5
such
as
tach/
,nea5
c/ano
sis5
retrac
tions5
grunti
ng5
and
nasal
%larin
g
NO
TE
*O
R
CH
AR
AC
TE
RIS
TIC
S
3=A
O*
H=
"O
GL
=C
EM
IAA
Abno'
all!
lo<
le)el
of
$lucos
e :less
t#an
38
$/(
L in
t#e
fi'st
5-
#ou'
.0
$/(
L
afte'
t#e
fi'st 3
(a!s
of life
N -.
No'
al
bloo(
$lucos
e le)el
is .8
to a %9
(a!9
ol(
neona
te an(
08 to
78
neona
te
ol(e'
t#an %
(a!
)ncre
ased
res,ir
ator/
rate
.6itc
3AB
hing5
nervo
usnes
s5 or
tre+o
rs
!nsta
0le
te+,e
rature
#/ano
sis
NURS
IN
G
INT
ER
;E
NTI
ON
A
%.
Mo
nito
'
fo'
si$n
s of
'es
&i'a
to'!
(ist
'ess
-.
Mo
nito
'
bili
'ub
in
an(
blo
o(
$luc
ose
le)e
ls
3.
Mo
nito
'
<ei
$#t
..
3A1
(ee
d
earl
/5
6it
h
1:
K
glu
cos
e in
6at
er5
0re
ast
+il
45
or
%or
+ul
a as
,re
scri
0ed
0.
Ad
+in
iste
r )V
glu
cos
e to
trea
t
nec
ess
ar/
and
as
,re
scri
0ed
4.
Monito'
fo'
e(ea
5.
Moni
3A2
to'
fo'
t'eo
's &
sei3u'
es
SMALL *OR
GESTATION
AL AGE
A.
Desc'i
&tionA
A
neona
te
<#o is
&lotte
( at
o'
belo<
t#e
%Ot#
&e'ce
ntile
on t#e
int'au
te'ine
$'o<t
#
cu')e
N&.
E" F1
Predis
,osin
g
%actor
is
7ater
nal
S+o4i
ng
1.
Assess
ent
3A3
%.
*etal
(ist'e
ss
-.
Gestat
ional
a$e
an(
&#!sic
al
atu'
it!
3.
Lo<e'
e( o'
ele)at
e(
bo(!
te&e
'atu'e
..
"#!sic
al
abno'
aliti
es
0.
H!&o
$l!ce
ia
4.
Si$ns
of
&ol!c!
t#ei
aA
a.
Ru((!
a&&ea'a
nce
b.
C!anosi
s
c.
>aun(ic
e
3A4
5.
Si$ns
of
infecti
on
6.
Si$ns
of
as&i'a
tion of
econ
iu
N&.
E"
&0tai
ning a
0lood
sa+,l
e to
deter
+ine
glucos
e level
6ould
have
the
highe
st
,riorit
/ to
on
SGA.
A
co++
on
co+,l
icatio
n o%
the
SGA
ne60o
rn
i++e
diatel
/ a%ter
0irth
is
h/,og
l/ce+i
a
3A5
0ecau
se o%
the
increa
sed
+eta0
olic
rate in
res,o
nse to
heat
loss
and
,oor
he,ati
c
gl/cog
en
stores.
.he
SGA
ne60o
rn
+a/
also
have
su%%er
ed
intrau
terine
h/,o$
ia5
6hich
de,let
es
glucos
e.
C.
I&le
enta
tion
%.
Maintai
n
ai'<a!
-.
Maintai
n bo(!
te&e'a
tu'e
3.
Obse')e
fo'
3A6
si$ns of
'es&i'at
o'!
(ist'ess
..
Monito'
fo'
infectio
n an(
initiate
easu'e
s to
&'e)ent
se&sis
0.
Monito'
bloo(
$lucose
le)els
an( fo'
si$ns of
#!&o$l!
ceia
4.
Initiate
ea'l!
fee(in$s
an(
onito'
fo'
si$ns of
as&i'ati
on
5.
"'o)i(e
stiulat
ionD
suc# as
touc#
an(
cu((lin
$
A. NER;OUS
S=STEM
ANOMALIES
9
M
3A$
9
9
9
9
S
9
9
9
D
Assess
ne<bo
'nIs
'es&i'
ato'!
'ateD
(e&t#
an(
'#!t#
.
Auscu
ltate
lun$
soun(
.
NoteA
7econi
u+
stained
s/ndro
+e o%
P&S.
7A.!
E
neonat
es
As,irat
ion o%
+econi
u+ is
0est
,revent
ed 0/
suction
ing the
neonat
e<s
naso,h
ar/n$
3A=
i++edi
atelt
a%ter
the
head is
delivere
d and
0e%ore
the
shoulde
rs and
chest
are
delivere
d. As
long as
the
chest is
co+,re
ssed in
the
vagina5
the
in%ant
6ill not
inhale
and
as,irat
e
+econi
u+ in
the
u,,er
res,irat
or/
tract.
7econi
u+
as,irati
on
0loc4s
the air
%lo6 to
the
alveoli5
leading
to
,otenti
all/ li%e
threate
ning
res,irat
or/
co+,lic
ations.
3AA
Suctio
n
e)e'!
-
#ou's
o'
o'e
often
as
necess
a'!
"ositi
on
ne<bo
'n on
si(e
o'
bac2
<it#
t#e
nec2
sli$#tl
!
e,ten
(e(
A(i
niste'
O-D
antici
&ate
t#e
nee(
fo'
C"A"
o'
"EE"
Conti
nue to
assess
t#e
ne<bo
'nIs
'es&i'
ato'!
status
closel
!.
Encou
'a$e
as
uc#
&a'en
tal
&a'tic
i&atio
4BB
n in
t#e
ne<bo
'nIs
ca'e
as
con(it
ion
allo<s
-.
A(i
niste'
I;
flui(s
afte'
bi't#
to
&'o)i
(e
Gluco
se to
&'e)e
nt
#!&o$
l!cei
aD
onit
o'
closel
! t#e
infusi
on
'ate.
He&t
t#e
infant
un(e'
a
'a(ia
nt
#eat
<a'
e' to
&'ese'
)e
ene'$
!
Monit
o'
bab!Is
<ei$#
tD
se'u
elect'
4B1
ol!tes
an(
ensu'
e
a(eFu
ate
flui(
inta2e
Meas
u'e
u'ine
out&u
t b!
<ei$#i
n$
(ia&e'
s
C#ec2
fo'
bloo(
stools
to
e)alua
te fo'
&ossib
le
blee(i
n$
f'o
intesti
nal
t'act.
Hee&
a
'estful
en)i'o
nent
.
3.
Antici
&ate
t#e
infant
s nee(
to be
b'east
fee(
Deo
nst'at
e
tec#ni
Fue
fo'
4B2
fee(in
$ to
ot#e
'D note
&'o&e
'
&ositi
onin$
of t#e
infant
D
Jlatc#
in$
onK
tec#ni
FueD
'ate
of
(eli)e
'! of
fee(in
$ an(
f'eFue
nc! of
bu'&i
n$
"'o)i
(e a
'ela,e
(
en)i'o
nent
(u'in
$
fee(in
$
A(Nus
t
f'eFue
nc!
an(
aou
nt of
fee(in
$
acco'
(in$
to
infant
s
'es&o
nse
Alte'n
ate
fee(in
$
4B3
&'oce
(u'e
:ni&&l
e an(
$a)a$
e
fee(in
$+
acco'
(in$
to
infant
s
abilit!
.
Monit
o'
ot#e
'Is
effo'tD
&'o)i
(e
fee(b
ac2
an(
assista
nce as
nee(e
(
Su$$e
st
ot#e
' to
onit
o'
infant
s
<ei$#
t
&e'io(
icall!
-.
Ris2 fo'
flui( )olue
(eficit
'elate( to
insensible
<ate' loss at
bi't#
3.
Ineffecti)e
infant
fee(in$
&atte'n
4B4
%.
;ita
in H
:AFua
e&#
!ton+
Use
fo'
&'o&#
!la,is
to
t'eat
#eo'
'#a$ic
(iseas
e of
t#e
ne<bo
'n
Si(e
effectsA
H!&e'
bili'u
binu'i
a
-. E!e
&'o&#
!la,is
3. :E'!t
#'o!cin
8.0M
Ilot!cinD
Tet'ac!cli
ne %M
Sil)e'
Nit'ate
%M
"'o&#
!lactic
easu
'e to
&'otec
t
a$ains
t
Neisse
'ia
$ono'
'#oea
e an(
C#la
!(ia
t'ac#o
4B5
atis
Si(e
effectsA
Sil)e'
nit'at
e can
cause
c#ei
cal
conNu
cti)iti
s
D'u$
stu(!
ET
tube
Suctio
n
cat#et
e'
1e(si
(e
eFui&
ent
Meco
niu
as&i'a
tion
s!n('
oe
Res&i
'ato'!
(ist'e
ss
s!n('
oe
NOTEA
Post +ature
neonates
have
di%%icult/
+aintainin
g glucose
reserves.
&ther
co++on
,ro0le+s
include
7econiu+
as,iration
s/ndro+e5
4B6
,ol/c/the+i
a5
congenital
ano+alies5
sei8ure
activit/ and
cold stress.
N&.
E" .he
in%ant 6ho
are
e$,osed to
high
0lood-
glucose
levels in
utero +a/
e$,erience
ra,id and
,ro%ound
h/,ogl/ce
+ia a%ter
0irth
0ecause o%
the
cessation
o% a high
in-utero
glucose
load. .he
s+all-%or-
gestational
-age
in%ant has
use u,
gl/cogen
stores as a
result o%
intrauterin
e
+alnutriti
on and
has
0lunted
he,atic
en8/+atic
res,onse
6ith
6hich to
carr/ out
gluconeog
enesis.
NOT
4B$
EA .he
,atient
6ith ,ost-
ter+
,regnanc/
is at high
ris4 %or
decreased
,lacental
%unctionin
g5
there%ore
increasing
the ris4 o%
inadeDuat
e o$/gen
circulation
to the
%etus
Co&
licatio
ns
1est
&ositi
on
Resus
citatio
n
NOT
EA
'esus
citati
on
beco
es
i&o
'tant
fo'
infan
t <#o
fails
to
ta2e
fi'st
b'eat
# o'
(iffic
ult!
ain
taini
n$
a(eF
uate
4B=
'es&i
'ato'
!
o)e
ent
s on
#is
o<n.
Suctio
nin$
NOT
EA
all
o<
s
'e
o
)in
$
uc
us
an
(
&'
e)
ent
s
as
&i'
ati
on
of
an
!
uc
us
an
(
a
nio
tic
flu
i(
&'
ese
nt
in
t#e
o
ut
4BA
#
an
(
no
se
of
t#e
ne
<b
o'
n.
To
est
abl
is#
cle
a'
ai'
<a
!.
Intub
ations
NOT
EA
#e
a(
of
t#
e
inf
an
t
in
ne
ut
'al
&o
sit
io
n
<i
t#
to
<e
l
un
(e
'
s#
ou
l(
e'.
41B
1est
&'oce
(u'e
Sono$
'a
Sc'ee
nin$
test
Inc'ea
se(
#eat
oc'it
le)el
Dec'e
ase(
se'u
$lucos
e
Long
A thin
6ith
crac4
ed
s4in
6hich
is
loose5
6rin4l
ed
and
strain
ed
greeni
sh
/ello6
5 6ith
no
verni$
nor
lanug
o
Long
nails
6ith
%ir+
s4ull
1ide
e/ed
alertn
ess o%
one
+onth
old
411
0a0/
Mate'
nal &
c#il(
nu'sin
$S a
(e)elo
&ent
al
a&&'o
ac# to
co&'
e#ensi
)e
c$fns
an(
ncle,
'e)ie
<S 0
t#
e(.
"a$e
%3%
Lo<
socioe
cono
ic
le)el
"oo'
nut'iti
onal
status
Lac2
of &'e
natal
ca'e
Multi
&a'ou
s
ot#e
'Is
Ci$a'
ette
so2i
n$
T#e
a$e of
t#e
ot#e
' :t#e
#i$#es
t
inci(e
nce is
412
in
ot#e
'Is
!oun$
e'
t#an
a$e
-8.+
Mot#e
'Is
<it#
(iabet
es
ellit
us
Con$e
nital
abno'
aliti
es
suc#
as
o&#
alocel
e.
1o(!
is
co)e'e
( <it#
lanu$
o
Ol(
an
facies
Cont'
ibutin
$
facto'
s
"OST
TER
M
IN*A
NT
A
neona
te
bo'n
afte'
.-
<ee2s
a$e of
$estati
on
413
"OST
TER
M
IN*A
NT
*i$u'
e -6
Defini
tion
Give
the
+othe
r
o$/ge
n 0/
+as4
durin
g the
0irth
to
,rovid
e the
,reter
+
in%ant
6ith
o,ti+
al
o$/ge
n
satura
tion at
0irth (
@3-
J:K9.
Kee,i
ng
+ater
nal
analg
esia
and
anest
414
hesia
to a
+ini+
u+
also
o%%ers
the
in%ant
the
0est
chanc
e o%
initiat
ing
e%%ecti
ve
res,ir
ation.
Bedsi
de
larng/
osco,
e5
endotr
achea
l tu0e5
suctio
n
cateth
ers
and
s/nthe
tic
sur%ac
tant to
0e
ad+in
istere
d 0/
the
endotr
achea
l tu0e.
)n%ant
+ust
0e
4e,t
6ar+
durin
g
resusc
itation
,roce
dures
so he
or she
415
is not
e$,en
ding
e$tra
energ
/ to
increa
se the
+eta0
olic
rate to
+aint
ain
0od/
te+,e
rature
.
&0ser
ve %or
chang
es in
res,ir
ations
5 color
and
vital
signs
#hec4
e%%ica
c/ o%
)solett
e"
+aint
ain
heat5
hu+id
it/
and
o$/ge
n
conce
ntrati
on5
ad+in
ister
o$/ge
n onl/
i%
necess
ar/
7aint
ain
ase,ti
c
techni
416
Due to
,reve
nt
in%ecti
on
Adher
e to
the
techni
Dues
o%
gavag
e
%eedin
g %or
sa%et/
o%
in%ant
&0ser
ve
6eigh
t-gain
,atter
ns
Deter
+ine
0lood
gases
%reDue
ntl/ to
,reve
nt
acidos
is.
)nstit
ute
,hotot
hera,
/
6hen
h/,er
0iliru
0ine+
ia
occur
s
Su,,o
rt
,arent
s 0/
letting
the+
ver0al
i8e
and
41$
as4
Duesti
ons to
reliev
e
an$iet
/.
Provi
de
li0eral
visitin
g
hours
%or
,arent
s5
allo6
the+
to
,artici
,ate
in
care.
Arran
ge
%ollo6
-u,
0e%ore
and
a%ter
discha
rge 0/
a
visitin
g
nurse.
(7os0
/<s
#o+,rehe
nsive
evie6 o%
Nursing
%or
N#LE>-
N ,age
21H9
1. is4
%or
%luid
volu
+e
de%ici
t
relate
d to
41=
insen
si0le
6ater
loss
at
0irth
and
s+all
sto+
ach
ca,a
cit/
2. is4
%or
as,ir
ation
relate
d to
6ea4
or
a0se
nt
gag
re%le
$ a
nd?or
ad+i
nistr
ation
o%
tu0e
%eedi
ngs
2. */,o
ther
+ia
relate
d to
lac4
o%
su0c
utane
ous
and
0ro6
n %at
de,os
its5
inade
Duate
shive
r
res,o
nse5
i++a
ture
41A
ther
+ore
gulat
ion
cente
r5
large
0od/
sur%a
ce
area
in
relati
on to
0od/
6eig
ht5
and?o
r
lac4
o%
%le$io
n o%
e$tre
+itie
s
to6ar
d the
0od/.
B. is4
%or
in%ect
ion
relate
d to
i++a
ture
i++
une
res,o
nse5
stasis
o%
res,i
rator
/
secre
tions5
and?
or
as,ir
ation
3. )+0a
lance
d
nutrit
42B
ion"
less
than
0od/
reDui
re+e
nts
relate
d to
lac4
o%
energ
/ to
suc4
and?o
r
6ea4
or
a0se
nt
suc4i
ng
re%le
$.
( 7o
s0/<s
#o+
,rehe
nsive
evie
6 o%
Nursi
ng
%or
N#L
E>-
N
,age
21H9
1e(si(e
eFui&ent
"'e(is&osin$ *acto'#hild undergoes a gro6th s,urt during ,u0ert/. (,. @J@5 .e$t0oo4 o% Basic Nursing
Li,,incott H
th
ed.9!n4no6n 0ut generall/ thought to result %ro+ triggered environ+ent.N&.E" sa+e 6?
+enigocele #linical 7ani%estationDi+,le is ,resent over the 0ac40one. (,. @J@5 .e$t0oo4 o% Basic Nursing
Li,,incott H
th
ed.9E$ternal c/st de%ect in the s,inal cord usuall/ at the +idline 7eningitis U in%la++ation o%
the +eninges covering the s,inal cord.Screening ? Diagnostic .est>-ra/ (s+all tu%t o% hair or ,ort urine
strain is so+eti+es ,resent in the verte0ral are9 ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9Neurologic E$a+ination-indicate loss o% neurologic %unctions 0elo6 the de%ect.Note" sa+e 6ith
+eningocele7aGor Surger/Surger/ i% necessar/ (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9La+inecto+/La+inecto+/Pur,ose o% Surger/.o ,revent %urther deterioration o% neural %unction..o
,revent %urther co+,lications.Post-&,erative Nursing care7easure head si8e to deter+ine i% h/roce,halus is
develo,ing7easure head si8e to deter+ine i% h/roce,halus is develo,ingPossi0le surgical
co+,lication*/droce,halus*/droce,halusBest Position (or Pre-o,?Post-o, A dseNote" Sa+e 6?
7eningceleDisease #o+,lication7eningitis-i% sac 6ill ru,tured then in%ection 6ill occurDrugs"Anti0iotics-
to ,revent in%ectionNote" Sa+e 6? 7eningceleNursing Diagnosis and )ntervention)+,aired s4in )ntegrit/
related to i+,aired +otor A sensor/ %unction.Note" Sa+e 6? 7eningcele
421
#
#
Nursing alert"
1. Prevent %urther da+age.
2. 7ost co++on ,ro0le+ is loss o% sensation in the legs (,rotect child against ,ossi0le leg inGur/.
2. S4in e$a+ination" ,ressure areas and tight clothing.
B. #hange dia,ers i% necessar/ a%ter voiding and de%ecating.
3. Patient is e$tre+el/ sensitive to late$. .he nurse +ust +a4e sure the/ do not co+e in contact 6ith
ite+s such as tourniDuets5 catheters5 ru00er 0ands5 gloves5 0alloons5 various tu0es +ade o% late$.
H. (olic acid (%olate9 ta4es during ,regnanc/ to reduce the severit/.
I. (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
@.
J.
1:.
Ris2 fo' Infection 'elate( to containation
Nu'sin$ Inte')entionsA "'otectin$ t#e s2in inte$'it!
%. Avoid ,ositioning on the in%antXs 0ac4 to ,revent ,ressure on the sac.
-. Do not &lace an! co)e'in$ (i'ectl! o)e' t#e sac.
3. Obse')e sac fo' e)i(ence of i''itation o' lea2a$e of CS*
.. !se ,rone ,osition 6? hi,s slightl/ %le$ed to decrease tension on the sac.
0. Place a %oa+ ru00er ,ad? s+all ,illo6 or roll dia,er 0et6een the in%ant<s legs to +aintain hi,s in
a0duction A to ,revent or counteract su0lu$ation.
4. "'o)i(e s2in ca'e es&eciall! an2lesD 2neesD ti& of noseD c#ee2s & c#in.
5. "'o)i(e &assi)e 'an$e of otion e,e'cise.
6. Use foa o' fleece &a( to 'e(uce &'essu'e of t#e att'ess a$ainst t#e s2in.
7. A)oi( touc#in$ t#e sac.
422
"'e)entin$ Infection
%. Hee& a'ea clean f'o u'ine an( feces
-. Hee& t#e infant clean es&. buttoc2s & $enitalia
3. A&&l! ste'ile $au3e /oistene( to<el an( <atc# fo' an! si$ns of infection.: fe)e'D i''itabilit!D
let#a'$!D oo3in$ of flui( o' &us f'o t#e sac+
"'one9 to inii3e t#e tension on t#e sac/'is2 fo' t'aua :RationaleATo &'e)ent &'essu'e on t#e
incision+
*i, slightl/ %le$ed and a0ducted
(eet hanging5 %ree o% +attress and slight trendelen0urg ( reduce s,inal %luid9 (,.22H5 7os0/<s
#o+,rehensive evie6 %or Nursing N#LE> N9
Paral/sis5 hi, destruction5 4nee %le$ion contracture5 sensor/ loss (,. 2HH5 Ph/sical 7edicine A
eha0ilitation Basic5 Garrison9
)n%ection (,atient is o,en catheteri8ed9. (,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
Monito' fo' si$n of inc'ease int'ac'annial &'essu'e
A)oi( s&inal co'( (aa$e
ange o% +otion (,assive and active9 ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
"'enatal Sc'eenin$:%
st
T'ieste'+
1loo( test Jt'i&le sc'eenK
- Inc'ease( se'u al&#a &'otein.
"'enatal ult'asoun(
Aniocentesis
Elective a0ortion ( ,. @J@5 .e$t0oo4 o% Basic Nursing Li,,incott H
th
ed.9
423
Afte' bi't#
S&ine @9'a! 'e)eals t#at e,act e,tent & location of t#e (efect.
S&ine Ult'asoun( to (ete'ine s&inal co'( abno'alities.
CT scan/ MRI
1# *alo1o&e :*arca&;
2# *ature of the dru"<
*arcotic a&ta"o&ist
Side effects<
7yperte&sio&, irritability, tachycardia
2. Sur%actan ( Survanta9
B. Nature o% the drug"
Lung sur%actant to i+,rove lung co+,liance
Side e%%ect"
.ransient 0rad/cardia5 rales
5# @itami& L :6Huamephyto&;
,se for prophyla1is to treat hemorrha"ic disease of the &ewbor&#
Side effects<
7yperbilirubi&uria
6# .ye prophyla1is
$# :.rythromyci& B#5C !lotyci&, 0etracycli&e 1C
=# Silver Nitrate 1K ( not alread/ used U causes che+ical conGunctivitis;
+rophylactic measure to protect a"ai&st *eisseria "o&orrhoeae a&d 3hlamydia trachomatis
Side effects<
Silver &itrate ca& cause chemical co&uctivitis
Chad)ic8/s si*n is a bluish colorin* of the #a*inal mucosal that occurs as early
as : )ee8s *estation. ationale1 due to increase #ascularity < blood #essel
en*or*ement.
Increase si2e of the uterus
W P Pre*nancy "est
S Secretion of +C- in the urine 0%ro* "est7. ,etectable 9C days after the missed
period
. "he fetal heartbeat typically can be heard and fetal rebound is possible bet)een
9; and AA )ee8s. "he fetal outline becomes palpable and the fetus is hi*hly
mobile bet)een A; and E9 )ee8s. (ra@ton +ic8s contractions increase in
fre4uency and intensity bet)een EA and EF )ee8s.
Sur*ical sterili2ation of the male in#ol#es cuttin* the ductus deferens.
&asectomy1 &as ,eferens is cut. "he man can resume se@ after one )ee8 or )hen the sperm count
indicates C count or A ne*ati#e sperm count ha#e been e@amined.
4e&erally it reHuires 6 > 36 eaculatio&s to re&der &e"# sperm cou&t
425
In order to *et for semen analysis3 collect them in a clean *lass not plastic3 because it may affect the
spermato2oa. No se@ for E days before the semen collection < no drin8in* of alcohol for 9 day. "he first
portion of the semen has a hi*h ration of sperm.