N106
Download
1 / 63

N106 - PowerPoint PPT Presentation


  • 125 Views
  • Updated 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.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
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
Slide1 l.jpg

N106

Nursing Care of the

Expanding Family


Outline l.jpg
Outline

  • Issues & Trends

  • Menstrual Cycle

  • Conception

  • Fetal Development


Issues and trends l.jpg
Issues and Trends

  • Family Centered

  • Role of Nurse

  • Legal and Ethical

  • Cultural Influence

  • Client Teaching



Slide5 l.jpg

Conception

Sperm penetration of an ovum



Fetal development l.jpg
Fetal Development

  • Ovum (pre-embryonic stage) – first 2 weekszygotemorulablastocyst

  • Embryonic stage – weeks 3 to 8

  • Fetal stage – 8 weeks to birth


Slide8 l.jpg

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).


Slide9 l.jpg

Foramen ovale 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).

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.


Outline10 l.jpg
Outline 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).

  • Terminology

  • Pregnancy dating

  • Signs of Pregnancy

  • Normal Physical Changes of Pregnancy

  • Psychological Changes

  • Nutrition

  • Medication Admin


Terminology l.jpg
Terminology 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).

  • 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 l.jpg
Pregnancy dating 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).

  • 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


Slide13 l.jpg

McDonald’s method is used to assess fundal height. 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).


Slide14 l.jpg

The TPAL approach 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).


Signs and symptoms of pregnancy l.jpg
Signs and symptoms of pregnancy 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).

  • Presumptive

  • Probable

  • Positive auscultation of FHTfetal movement felt by examinerfetus visualized by US


Physiologic changes with common discomforts l.jpg
Physiologic changes 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). with Common Discomforts

  • Reproductive

  • Cardiac

  • Respiratory

  • Gastrointestinal

  • Renal

  • Integumentary

  • Endocrine

  • Musculoskeletal

  • Neurological


Reproductive and cardiac l.jpg

uterus 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).

cervix

vagina

ovaries

breast

heart

heart sound

pulse

blood volume

cardiac output

peripheral vasodilatation

B/P

blood components

Reproductive and Cardiac


Slide18 l.jpg

Vena caval syndrome. 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).


Respiratory and gastrointestinal l.jpg

Thoracic circumference 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).

Diaphragm

Oxygen consumption

Tidal volume

Gingivitis and bleeding gums

Heartburn

Nausea

Constipation

Gallstones

Respiratory and Gastrointestinal


Endocrine hormones l.jpg
Endocrine/ hormones 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).

  • Human Chorionic Gonatropin (HCG)

  • Human Placenta Lactogen (HPL)

  • Relaxin

  • Estrogen

  • Progesterone

  • Oxytocin

  • Prolactin


Physiologic changes l.jpg
Physiologic changes 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).

  • Renal

  • Integumentary chloasmalinea nigrastriae gravidarum

  • Musculoskeletallordosisdiastasis recti

  • Neurological


Psychological changes l.jpg
Psychological changes 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).

  • 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


Nutrition l.jpg
Nutrition 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).

  • 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


Slide24 l.jpg

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


Medication administration l.jpg
Medication Administration 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).

  • 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 l.jpg
Prenatal Education 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).

  • Early pregnancy classes

  • Childbirth Preparation classes

  • Methods of childbirth

    BradleyLamaze


Assessment during pregnancy l.jpg
Assessment during Pregnancy 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).

  • 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 l.jpg
Danger Signs of Pregnancy 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).

  • 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


Fetal assessment l.jpg
Fetal Assessment 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).


Ante partal fetal assessment l.jpg

Labs 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). Alpha-fetoprotein screening (MSAFP)

Ultrasound

glucose tol test (GTT)

AmniocentesisL/S ratio and PG

Nonstress test (NST)

Contraction stress test (CST)

Ante-partal Fetal Assessment


Slide31 l.jpg

Amniocentesis 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).


Slide32 l.jpg

Reactive NST 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).

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.


Slide33 l.jpg

Nonreactive NST 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).

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.


Slide34 l.jpg

CST 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).

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 l.jpg
Complications Antepartal 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).

  • Gestational Diabetes

  • Hemorrhage - abortion

  • Hyperemesis Gravidarum

  • PROM – premature rupture of membranes

  • Preterm labor

  • Pregnancy Induced Hypertension PIH

  • Substance abuse

  • Infections – TORCH


Gestational diabetes l.jpg
Gestational Diabetes 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).

  • 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 l.jpg
Therapeutic Management 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).

  • 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 l.jpg
Insulin Therapy 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).

  • 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 l.jpg

Hyperglycemia 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). fatigueflushed hot skindry mouth, excessive thirstfrequent urinationrapid respheadachedepressed reflexes

Hypoglycemiashakinesssweatingcold, clammy skinpallordisorientationirritabilityheadachehungerblurred vision

Teaching Self-Care – S&S


Spontaneous abortion l.jpg
Spontaneous Abortion 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).

  • Incidence

  • Threatened

  • Inevitable/imminent

  • Complete

  • Incomplete

  • Missed

  • Recurrent


Slide41 l.jpg

Threatened 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).

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


Slide42 l.jpg

Imminent 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).

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


Slide43 l.jpg

Incomplete 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).

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


Ectopic pregnancy l.jpg
Ectopic Pregnancy 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).

  • 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


Slide45 l.jpg

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


Complications of pregnancy l.jpg

Complications of pregnancy common site is within the fallopian tube, hence the name “tubal pregnancy.”

Hyperemesis gravidarum


Hyperemesis gravidarum l.jpg
Hyperemesis Gravidarum common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • 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 l.jpg
Reducing nausea and vomiting common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • 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 l.jpg

Complications of Pregnancy common site is within the fallopian tube, hence the name “tubal pregnancy.”

Premature Rupture of Membranes


Premature rupture of membranes prom l.jpg
Premature rupture of membranes (PROM) common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • 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 l.jpg
Nursing Care for PROM common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • 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


Complications of pregnancy52 l.jpg

Complications of Pregnancy common site is within the fallopian tube, hence the name “tubal pregnancy.”

Preterm Labor


Premature rupture of membranes prom53 l.jpg
Premature rupture of membranes (PROM) common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • 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 l.jpg

Complications of Pregnancy common site is within the fallopian tube, hence the name “tubal pregnancy.”

Hypertensive Disorders


Pregnancy induced hypertension l.jpg
Pregnancy Induced Hypertension common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • 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 l.jpg
Classification of hypertensive disorders of pregnancy common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • Pregnancy-induced hypertension (PIH)

  • Preeclampsia

  • Eclampsia

  • HELLP


Pih hellp syndrome reflects severity of disease l.jpg

Signs and Symptoms common site is within the fallopian tube, hence the name “tubal pregnancy.”headachesvisual 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 l.jpg
PIH - management common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • 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 l.jpg
PIH – eclampsia nursing interventions common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • 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 l.jpg

Complications of pregnancy common site is within the fallopian tube, hence the name “tubal pregnancy.”

Substance Abuse

Types of substance

Risk Factors

Signs and Symptoms

Nursing Management


Complications of pregnancy61 l.jpg
Complications of Pregnancy common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • Gestational Diabetes


Complications of pregnancy62 l.jpg

Complications of Pregnancy common site is within the fallopian tube, hence the name “tubal pregnancy.”

Infections during Pregnancy

TORCH


Infections l.jpg
Infections common site is within the fallopian tube, hence the name “tubal pregnancy.”

  • T – toxoplasmosis

  • O - other

  • R – rubella

  • C – cytomegalovirus

  • H – herpes simplex virus