Skip this Video
Download Presentation

Loading in 2 Seconds...

play fullscreen
1 / 63

N106 - PowerPoint PPT Presentation

  • Uploaded on

N106. Nursing Care of the Expanding Family. Outline. Issues & Trends Menstrual Cycle Conception Fetal Development. Issues and Trends. Family Centered Role of Nurse Legal and Ethical Cultural Influence Client Teaching. Ovarian and Endometrial Cycles. . Menstrual Cycle. Conception.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'N106' - menefer

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript


Nursing Care of the

Expanding Family

  • Issues & Trends
  • Menstrual Cycle
  • Conception
  • Fetal Development
issues and trends
Issues and Trends
  • Family Centered
  • Role of Nurse
  • Legal and Ethical
  • Cultural Influence
  • Client Teaching


Sperm penetration of an ovum

fetal development
Fetal Development
  • Ovum (pre-embryonic stage) – first 2 weekszygotemorulablastocyst
  • Embryonic stage – weeks 3 to 8
  • Fetal stage – 8 weeks to birth

Figure 3–12 The actual size of a human conceptus from fertilization to the early fetal stage. The embryonic stage begins in the third week after fertilization; the fetal stage begins in the ninth week. Source: Adapted from Marieb, E. N. (1998).


Foramen ovale

Ductus arteriosus

Ductus Venosus

Figure 3–11 Fetal circulation. Blood leaves the placenta and enters the fetus through the umbilical vein. After circulating through the fetus, the blood returns to the placenta through the umbilical arteries. The ductus venosus, the foramen ovale, and the ductus arteriosus allow the blood to bypass the fetal liver and lungs.

  • Terminology
  • Pregnancy dating
  • Signs of Pregnancy
  • Normal Physical Changes of Pregnancy
  • Psychological Changes
  • Nutrition
  • Medication Admin
  • Gravida - # of times a uterus has held a pregnancy
    • Primigravida and Multigravida
  • Para - # of times a uterus held a pregnancy past 20 wks – Primiparity and Multiparity
  • Abortion – less than 20 weeks – miscarriage
  • Viability – past 24 weeks – Federal /State
  • Preterm – 20-37 weeks
  • Term – 38-42 weeks
  • Post term – after 42 wks
  • BOW – bag of waters
  • Bloody show – when cervix starts to dilate
pregnancy dating
Pregnancy dating
  • Nagele’s rule – add 7 days to first day of LMP and count back 3 months
  • McDonald’s rule – fundal height = week of gestation +/- 2-4 weeks
  • Sonogram – early US at 7-13 weeks after LMP most accurate for dating pregnancy
signs and symptoms of pregnancy
Signs and symptoms of pregnancy
  • Presumptive
  • Probable
  • Positive auscultation of FHTfetal movement felt by examinerfetus visualized by US
physiologic changes with common discomforts
Physiologic changes with Common Discomforts
  • Reproductive
  • Cardiac
  • Respiratory
  • Gastrointestinal
  • Renal
  • Integumentary
  • Endocrine
  • Musculoskeletal
  • Neurological
reproductive and cardiac






heart sound


blood volume

cardiac output

peripheral vasodilatation


blood components

Reproductive and Cardiac
respiratory and gastrointestinal
Thoracic circumference


Oxygen consumption

Tidal volume

Gingivitis and bleeding gums





Respiratory and Gastrointestinal
endocrine hormones
Endocrine/ hormones
  • Human Chorionic Gonatropin (HCG)
  • Human Placenta Lactogen (HPL)
  • Relaxin
  • Estrogen
  • Progesterone
  • Oxytocin
  • Prolactin
physiologic changes
Physiologic changes
  • Renal
  • Integumentary chloasmalinea nigrastriae gravidarum
  • Musculoskeletallordosisdiastasis recti
  • Neurological
psychological changes
Psychological changes
  • First trimester – disbelief & ambivalence

focus: self-centered R/T physiologic changes

  • Second trimester – introspective focus: baby; fetus becomes real
  • Third trimester - pride and anxiety focus: labor / delivery & baby’s well-being
  • Affects size of baby
  • Wt gain 3.5 lbs during 1st trimester than 1 lb/wk
  • Total 25-35 lbs
  • Folic acid – prevent neural tube defects
  • Iron supplements – 30 mg daily
  • Additional 300 cal/day
  • Lactating requires 2700-2800 cal/day and 3000cc of fluids /day
  • Post partum 2200 to 2300 well balanced

Healthful eating Largest portion - grains, rice, bread, and pastaSmallest portion - fats, oils, and sweets,

medication administration
Medication Administration
  • Most medications cross placenta to fetus
  • Medications during PG can harm fetus
  • Pain meds in labor cross placenta
  • Newborn meds are Vitamin K & Erythromycin
  • PostPartum meds are oxytocics & analgesics
prenatal education
Prenatal Education
  • Early pregnancy classes
  • Childbirth Preparation classes
  • Methods of childbirth


assessment during pregnancy
Assessment during Pregnancy
  • Prenatal appointmentsmonthly first 6 monthsq 2 weeks in 7 & 8 monthweekly last month
  • Vag exam initial visit and 2-3 wks a EDC
  • Assessment each visitwt, B/P, P, R, fundal ht, FHT
danger signs of pregnancy
Danger Signs of Pregnancy
  • Vaginal Bleeding
  • Rupture of membranes
  • Swelling of the fingers, face, eyes
  • Headache
  • Visual disturbances
  • Persistent abdominal pain
  • Chills and fever
  • Painful urination
  • Persistent vomiting
  • Change in fetal movements
ante partal fetal assessment
LabsAlpha-fetoprotein screening (MSAFP)


glucose tol test (GTT)

AmniocentesisL/S ratio and PG

Nonstress test (NST)

Contraction stress test (CST)

Ante-partal Fetal Assessment

Reactive NST

Figure 14–5 Example of a reactive nonstress test (NST). Accelerations of 15 bpm lasting 15 seconds with each fetal movement (FM). Top of strip shows FHR; bottom of strip shows uterine activity tracing. Note that FHR increases (above the baseline) at least 15 beats and remains at that rate for at least 15 seconds before returning to the former baseline.


Nonreactive NST

Figure 14–6 Example of a nonreactive NST. There are no accelerations of FHR with FM. Baseline FHR is 130 bpm. The tracing of uterine activity is on the bottom of the strip.



Figure 14–8 Example of a positive contraction stress test (CST). Repetitive late decelerations occur with each contraction. Note that there are no accelerations of FHR with three fetal movements (FM). The baseline FHR is 120 bpm. Uterine contractions (bottom half of strip) occurred four times in 12 minutes.

complications antepartal
Complications Antepartal
  • Gestational Diabetes
  • Hemorrhage - abortion
  • Hyperemesis Gravidarum
  • PROM – premature rupture of membranes
  • Preterm labor
  • Pregnancy Induced Hypertension PIH
  • Substance abuse
  • Infections – TORCH
gestational diabetes
Gestational Diabetes
  • Develops during pregnancy
  • Risk factors: obesity, <25 yrs, family history, chronic hypertension, large birth wt, previous gestational diabetes
  • Screening: between 24-28 weeks a 50 g, 1 hour glucose challenge test (GCT) if 140 or above recommend 3 hour oral glucose tolerance test (OGTT)
  • Increased for PIH and fetal macrosomia
therapeutic management
Therapeutic Management
  • Diet – 2200 -2400 calories per day
  • Exercise – Moderate exercise for active women, regular activity for sedentary women
  • Blood glucose monitoring – if FBG >95 or PPBG >120 start on insulin
  • Fetal surveillance – 28 weeks ultrasound, amniocentesis, NST, CST, BPP
insulin therapy
Insulin Therapy
  • First trimester – insulin needs lower
  • Second and Third trimester – increased insulin due to placental hormones
  • During labor – based on blood glucose levels
  • Post Partum – insulin not needed due to abrupt cessation of placental hormones
teaching self care s s
Hyperglycemia fatigueflushed hot skindry mouth, excessive thirstfrequent urinationrapid respheadachedepressed reflexes

Hypoglycemiashakinesssweatingcold, clammy skinpallordisorientationirritabilityheadachehungerblurred vision

Teaching Self-Care – S&S
spontaneous abortion
Spontaneous Abortion
  • Incidence
  • Threatened
  • Inevitable/imminent
  • Complete
  • Incomplete
  • Missed
  • Recurrent


The cervix is not dilated, and the placenta is still attached to the uterine wall, but some bleeding occurs.



The placenta has separated from the uterine wall, the cervix has dilated, and the amount of bleeding has increased.



. The embryo or fetus has passed out of the uterus, but the placenta remains.

ectopic pregnancy
Ectopic Pregnancy
  • Pregnancy outside the uterine cavity
  • S & S of PG
  • Rupture at 6-12 weeks
  • Severe pain
  • Vaginal tenderness and shock
  • Treatment – salpingectomy if rupturedlinear salpingostomy if tube is intact
  • Care – assess for bleeding and pain, prepare for surgery, emotional support

Various implantation sites in ectopic pregnancy. The most common site is within the fallopian tube, hence the name “tubal pregnancy.”

complications of pregnancy

Complications of pregnancy

Hyperemesis gravidarum

hyperemesis gravidarum
Hyperemesis Gravidarum
  • Persistent, uncontrolled vomiting
  • Cause unknown may be high hCG or psychological problem – hydatidiform mole
  • S&S: Nausea and vomiting, weight loss, fatigue, signs of dehydration, signs of starvation
  • TX: antiemetics, IV fluids, quiet environment ,sedation, counseling
  • Care: Allow to verbalize
reducing nausea and vomiting
Reducing nausea and vomiting
  • 1) small portions q 2-3 hours
  • 2) attractively presented
  • 3) eliminate strong odors
  • 4) low-fat foods,
  • 5) easily digested carbohydrates, such as fruit, breads, cereal, rice and pasta
  • 6) soups and liquids taken between meals
  • 7) sitting upright to reduce gastric reflex
complications of pregnancy49

Complications of Pregnancy

Premature Rupture of Membranes

premature rupture of membranes prom
Premature rupture of membranes (PROM)
  • Diagnose – Nitrazine or fern test
  • Gestational age - more than 36 wks deliver if – ripe cervix, abnormal FHT, meconium stained fluid, possible infection, abnormal presentation Tx – walking, Prostaglandin
  • Gestational age between 32-35 weeksdeliver if – mature fetal pulmonary status, abnormal FHT, possible infection
  • Strategies – tocolytics, steroids, antibiotics
nursing care for prom
Nursing Care for PROM
  • Stay hospitalized until birth
  • Frequent VS & FHT q 4 hours
  • Frequent CBCs , mtr records “kick counts”
  • Check vaginal bleeding
  • No vag exams, restrict activity
  • A & Z for 7 days
premature rupture of membranes prom53
Premature rupture of membranes (PROM)
  • Diagnose – cramping and vag discharge prior to 20 and 37 weeks gestation
  • Tocolytics act by depressing smooth muscle, glucocorticoids accelerate fetal lung maturity
  • Nursing Care – monitor FHT & contractions, provide emotional support, manage side effects of tocolytics, teach what to do if occur at home
complications of pregnancy54

Complications of Pregnancy

Hypertensive Disorders

pregnancy induced hypertension
Pregnancy Induced Hypertension
  • Incidence – 8% of all pregnant woman
  • Risk factors
  • Etiology - Preeclampsia is due to generalized vasospasm
  • Cause remains unknown
  • Cardinal signs1) hypertension2) proteinuria3) weight gain of 2 lbs in one week
classification of hypertensive disorders of pregnancy
Classification of hypertensive disorders of pregnancy
  • Pregnancy-induced hypertension (PIH)
  • Preeclampsia
  • Eclampsia
pih hellp syndrome reflects severity of disease
Signs and Symptomsheadachesvisual changesoliguriahyperreflexiaepigastric pain

flu like symptomsgeneralized edemanausea and vomitingsevere elevated BPproteinuria

Criteria of diagnosishemolysiselevated liver enzymes AST(SGOT)>72U/L ALT(SGPT)>50U/L serum LDH>600IU/Llow platelet<100,000/mm

PIH - HELLP syndrome – reflects severity of disease
pih management
PIH - management
  • Dependent on severity of disease & gestational age of fetusActivity restriction / quiet environmentPharmacologic therapy

anticonvulsive therapy antihypertensive therapy stimulant for fetal surfactant

  • Only cure – delivery of the fetus
  • Goal – prevent eclampsia & other severe complications while allowing fetus to mature
pih eclampsia nursing interventions
PIH – eclampsia nursing interventions
  • Reduce risk of aspiration
  • Prevent maternal injury
  • Ensure maternal oxygenation after seizure
  • Ensure fetal oxygenation after seizure
  • Establish seizure control with MgSO4
  • Treat severe hypertension
  • Correct maternal acidemia
  • Initiate process of delivery
complications of pregnancy60

Complications of pregnancy

Substance Abuse

Types of substance

Risk Factors

Signs and Symptoms

Nursing Management

complications of pregnancy61
Complications of Pregnancy
  • Gestational Diabetes
complications of pregnancy62

Complications of Pregnancy

Infections during Pregnancy


  • T – toxoplasmosis
  • O - other
  • R – rubella
  • C – cytomegalovirus
  • H – herpes simplex virus