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Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Chapter 7 Conception and Development of the Embryo and Fetus Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Basic Concepts of Inheritance Human Genome Project (1990) Chromosomes 23 matched pairs DNA Genes Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Inheritance of Disease Multifactorial Genetic and environmental factors Examples: cleft lip, neural tube defects Unifactorial Single gene inheritance Examples: autosomal dominant, autosomal recessive, X-linked disorders Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Autosomal Dominant Inheritance Single altered gene Mutation Parent who is heterozygous for the trait 50% chance of passing trait to offspring Examples: Huntington’s disease, achondroplasia, neurofibromatosis Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Autosomal Recessive Inheritance Each parent has the altered gene 25% risk of passing trait to offspring Specific populations Sickle cell anemia more frequent in black populations Examples: phenylketonuria (PKU), cystic fibrosis Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley X-Linked Dominant Inheritance Altered gene on X chromosome X-linked dominant in father None of sons will inherit the disorder All of daughters will inherit the disorder Female with X-linked dominant trait 50% chance of passing trait to daughters Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley X-Linked Recessive Inheritance More common than X-linked dominant disorders Occur more frequently in males Female carrier 50% chance of passing to offspring Examples: hemophilia A, Duchenne muscular dystrophy Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Cellular Division Gametes Ova—female gamete Sperm—male gamete Gametogenesis Meiosis Mitosis Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Process of Fertilization Oocyte and sperm meet in fallopian tube Ovulation—cervical mucus changes 200 sperm reach fertilization site Capacitation Penetrates zona pellucida—prevents fertilization by other sperm Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Cellular Multiplication Cleavage—rapid cellular division Morula—solid ball of cells Blastocyst—inner mass of cells Embryoblast Trophoblast Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Implantation Zygote propelled by Cilia Peristalsis Reaches uterine cavity in 3 to 4 days Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Nidation Occurs by 10th day after fertilization Implantation bleeding Blastocyst is buried beneath the endometrial surface Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Placenta Develops from trophoblast cells Lacunae Chorionic villi Intervillous spaces Provides oxygenation, nutrition, waste elimination, and hormones Protects fetus Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Substance Transport Across Placenta Diffusion Active transport Pinocytosis Bulk flow and solvent drag Accidental capillary breaks Independent movement Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Placental Hormones Human chorionic gonadotrophin (hCG) Human placental lactogen (hPL) Progesterone Estrogen Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Development of the Embryo and Fetus Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Yolk Sac Develops 8 to 9 days after conception Essential for transfer of nutrients during second and third weeks of gestation Hematopoiesis Atrophies and is incorporated into umbilical cord Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Umbilical Cord Usual location—center of placenta 55 cm long (21 in); 1 to 2 cm diameter Vessels: one vein, two arteries Wharton’s Jelly: protects umbilical cord from compression Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Fetal Circulation Heart begins to beat and circulate blood by end of third week Umbilical vein: blood from placenta to fetus Low Po2 important to maintain fetal circulation Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Fetal Circulation Three unique shunts Ductus venosus: bypasses liver and enters inferior vena cava Foramen ovale: right and left atria to supply blood to head, and upper and lower extremities Ductus arteriosus: returning blood bypasses lungs Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Fetal Membranes and Amniotic Fluid Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Embryonic Membranes Early protective structures Two separate membranes Amnion—inner membrane, contains amniotic fluid Chorion—outer membrane, forms fetal portion of placenta Slightly adherent, form amniotic sac Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Purposes of Amniotic Fluid Protects and cushions fetus Maintains normal body temperature Symmetrical fetal growth Freedom of movement Essential for normal fetal lung development Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Amniotic Fluid Amount: 800 mL at 24 weeks Fetal urine and lung secretions primary contributors Slightly alkaline Contains antibacterial, other protective substances Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Human Growth and Development Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Pre-Embryonic Period First 2 weeks after conception Rapid cellular multiplication and differentiation Establishment of embryonic membranes and primary germ layers Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Embryonic Period Begins third week after fertilization through end of eighth week Organogenetic period: formation, differentiation of all organs Germ layers: ectoderm, endoderm, mesoderm Vulnerable to environmental insults Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Fetal Period Beginning ninth week until birth or termination of pregnancy Rapid body growth and differentiation of tissues, organs, and systems Less vulnerable stage Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Weeks 9 to 12 Body growth increases Ossification centers appear Intestines leave umbilical cord, enter abdomen External genitalia by week 12 Urine production begins Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Weeks 13 to 16 Very rapid growth Coordinated movements of limbs Ossification of skeleton Ovaries differentiated Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Weeks 17 to 20 Growth slows Quickening Vernix caseosa Lanugo By 20 weeks—fetus 300 g and 19 cm (7.3 in) Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Weeks 21 to 25 Gains weight Skin pink Rapid eye movements Surfactant by 24 weeks Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Weeks 26 to 29 If born, fetus may survive Weeks 30 to 40 Strong hand grasp reflex Orientation to light 38 to 40 weeks: 3000–3800 g and 45–50 cm (17.3–19.2 in) Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Threats to Embryonic and Fetal Development Chromosomes and teratogens Medications and other substances Vitamins, alcohol, tobacco, caffeine, drugs, radiation, and lead TORCH infections Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Nurse’s Role in Prenatal Evaluation Initial prenatal visit Assessment: cultural, emotional, physical, and physiological factors Education Genetic disorders Prenatal tests Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Heredity and Genetics Congenital anomalies Malformation Deformations Dysplasia Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Maternal Age and Chromosomes Age 35 and above Increased risk of chromosomal abnormalities Down syndrome Deletion Translocation Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Multifetal Pregnancy Monozygotic Develop from one zygote Division occurs at end of first week Dizygotic Develop from two zygotes Separate amnions and chorions Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Minimizing Threats to Embryo/Fetus Nurse’s role Assessment Environmental and lifestyle risks Knowledge Physical and psychosocial well-being Preconception counseling Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Chapter 8 Physiological and Psychosocial Changes During Pregnancy Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Hormonal Influences Pituitary hormones Influence ovarian follicular development Prompt ovulation Stimulate uterine lining Corpus luteum Estrogen: growth Progesterone: maintenance Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Ovarian Hormones Maintain endometrium Provide nutrition Aid in implantation Decrease uterine contractility Initiate breast ductal system development Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Reproductive System Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Uterus Patterns of uterine growth Estrogen, progesterone: hyperplasia, hypertrophy allow uterus to enlarge, stretch Weight increases from 70 g to 1100 g at term Increased blood flow Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Braxton-Hicks Contractions Irregular, painless Prepare uterine muscles If irregular and last <60 seconds, reassure woman Regular pattern or associated with other symptoms, seek medical attention Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Cervix Chadwick’s sign Goodell sign Softens Forms mucus plug Call if discharge bloody or yellow/green, foul odor, itching, or pain Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Vagina and Vulva Thickening of vaginal mucosa Rugae Becomes edematous More susceptible to yeast infections pH: decreases from 6.0 to 3.5 Discuss vulvar hygiene Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Other Reproductive Changes Ovaries Breasts Montgomery tubercles Increased pigmentation (areolae) Discuss bra size changes, options for infant feeding, and strategies for successful breastfeeding Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Integumentary System Hyperpigmentation Chloasma Linea nigra Cutaneous vascular changes Striae gravidarum Angiomas Palmar erythema Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Neurological System Decreased attention span Poor concentration Memory lapses Carpal tunnel syndrome Syncope Anticipatory guidance regarding changes Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Cardiovascular System Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Heart Position: pushed upward, laterally to left Cardiac hypertrophy due to increased blood volume, cardiac output Heart sounds: exaggerated first and third; systolic murmurs Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Blood Volume Plasma and erythrocyte volume increase Increased need for iron Physiologic anemia Teach regarding adequate hydration and diet high in protein, iron Increased fibrinogen volume Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Cardiac Output Blood pressure Stasis of blood in lower extremities: risk for varicose veins and venous thrombosis Encourage daily walks to enhance circulation, improve intestinal peristalsis Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Supine Hypotension Syndrome Pressure from enlarged uterus decreases venous return from lower extremities Hypotension, dizziness, diaphoresis, pallor Orthostatic hypotension Stagnation of blood in lower extremities Encourage to rise slowly; keep feet moving while standing Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Respiratory System Increased tidal volume Increased oxygen consumption Diaphragm elevates Increased chest circumference—dyspnea Educate regarding normal changes and symptoms Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Eyes, Ears, Nose, Throat Blurred vision—decreased intraocular pressure and corneal thickening Temporary condition Nasal stuffiness, congestion—increased mucus production Epistaxis Encourage increased fluid intake Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Gastrointestinal System Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Upper GI Tract Mouth Gingivitis, ptyalism, hypertrophy of gums, epulis Esophagus—pyrosis, reflux Stomach and small intestine Morning sickness, absorption of nutrients Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Lower GI Tract Large Intestine—constipation Liver and gallbladder Cholestasia, cholecystitis, cholelithiasis Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Urinary System Bladder Urinary frequency and urgency Kidneys and ureters Structural changes Functional changes Glomerular filtration rate increases Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Endocrine System Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Endocrine Glands Thyroid gland Increased T4 Progressive increase in basal metabolic rate Pituitary gland Prolactin Oxytocin Vasopressin Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Endocrine Glands Adrenal glands Increased cortisol Increased aldosterone Pancreas Increased number, size of beta cells Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Musculoskeletal System Postural changes Lumbar lordosis “Waddle” gait Calcium storage Decreased maternal serum calcium Lower extremity cramps Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Assessment and Health Education Comprehensive history and physical exam Ongoing education focusing on current trimester and physical changes Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Psychosocial Changes Decreased ability to deal with stress and cope with changes of pregnancy Major developmental phases— ambivalence and conflicting emotions Nursing care tailored through each pregnancy milestone Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Developmental and Family Changes Duvall: stages of family development Prepare for role as childcare providers Reorganize home, family member duties, patterns of money management Reorient family relationships Each pregnancy—adjust to transitions in relationships with each other, children Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal Role Transition Rubin—“tasks of pregnancy” Incorporate pregnancy into identity Acceptance of the child Reorder relationships Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Maternal Tasks of Pregnancy Seeking safe passage Securing acceptance Learning to give of self Committing self to the unknown child Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Pregnant Adolescent Normal adolescent developmental tasks conflict with tasks of pregnancy May not seek prenatal care Not future oriented—may not accept reality of unborn child Acceptance of pregnancy hindered Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Paternal Adaptation Styles of involvement: observer, expressive, and instrumental Couvade “Announcement” phase “Moratorium” phase “Focusing” phase Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Developmental Processes Grappling with the reality of pregnancy and the child Struggling for recognition as a parent Creating the role of involved father Seeking parenting information Couvade Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Adaptation of Siblings Reactions influenced by age and level of involvement with pregnancy Toddlers Regression Older children May not grasp reality of a baby in the family Adolescents Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Adaptation of Grandparents Age affects reactions Number and spacing of other grandchildren Perceptions of the role of grandparents Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Other Considerations Single mother Cultural influences High-tech management Societal influences Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Nursing Assessment of Psychosocial Changes Thorough history: family background, past obstetrical events, status of current pregnancy Each visit—ask about pregnancy experience, address concerns, offer anticipatory guidance Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Chapter 9 The Prenatal Assessment Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Prenatal Period Maternal reactions Ambivalence Maternal self-preservation World Health Report “Make Every Woman and Every Child Count” Prenatal care Societal support of pregnant women Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley CAREing for the Patient Nurse’s role Communicate Advocate Empower women Help woman become informed recipient of care Facilitate shared decision-making Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Stress and Pregnancy Nurse’s role Focus on communication, personalized care, education Provide support Offer stress management techniques Gain woman’s confidence Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Healthy People 2010 Access to care Barriers to service Health insurance Health provider barriers System barriers Social disparities Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families The First Prenatal Visit Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Nurse’s Role—First Prenatal Visit Build positive, nonthreatening relationship Therapeutic communication Avoid medical/technical jargon Provide user-friendly service Goal: to explain purpose of prenatal care; to establish specific goals Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Comprehensive Health History Biographical data Social history—intimate partner violence and drug use Psychological assessment Obstetric history Current pregnancy Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Signs and Symptoms of Pregnancy Presumptive Amenorrhea Nausea/vomiting Urinary frequency Breast tenderness Probable Piskacek sign Hegar sign Chadwick sign Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Pregnancy Tests Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Positive Signs of Pregnancy Fetal heartbeat Fetal movements Visualization of fetus Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Estimated date of birth (EDB) Naegele’s rule History Intercourse/signs and symptoms Date of last normal menstrual period Date of positive home pregnancy test Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Pregnancy Classification System Gravid/gravida/gravidity Nulligravida Primigravida Multigravida Parity GTPAL classification system Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Medical History Medical conditions Dental health Eye health Immunizations Hepatitis B infection Environmental hazards Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Gynecological History DES exposure Breast surgery/cancer/lumps/biopsies History of rape, abuse Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Gynecological History Infertility Surgeries Therapeutic/elective pregnancy terminations History of STIs Cervical pathology Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Screening and Diagnostic Tests Screening Rh factor, antibody screen Sexually transmitted infections HIV Cervical cancer Diagnostic To confirm presence of disease Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Prenatal Physical Examination Prepare patient and environment Obtain consent to be examined Ongoing interaction General assessment Nutritional assessment Abdominal palpation Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Focused Obstetrical Examination Head, neck, lungs Skin Breasts Abdomen Uterine size, fetal position, fundal height Vagina and pelvis Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Leopold Maneuvers First: determine fetal body part that occupies uterine fundus Second: determine location of fetal spine Third: compare fundus with lower uterine segment Fourth: determine ballottement; engagement Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Fetal Heart Auscultation 120 to 160 beats per minute Fetoscope Doppler ultrasound stethoscope Electronic fetal monitoring for high-risk pregnancies Non-stress test Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Subsequent Prenatal Examinations Maternal weight gain/edema Blood pressure Urine Uterine growth Fetal heart tones Fetal movements and presentation Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Assessing Special Populations Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Teenage Pregnancy Nurse’s role Heighten public awareness Empower women/families to reduce unwanted pregnancies Advocate for responsible sexual behavior Impact on society Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Teenage Pregnancy Cultural influences Identifying adolescents at risk Impact on developmental tasks Delayed entry into care Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Nursing Care of Pregnant Adolescent Assessment Closely monitor for iron deficiency anemia, STIs, preeclampsia High-risk behaviors Knowledge regarding personal care and care of infant Promote optimal nutrition Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley The Older Gravida: Considerations in Pregnancy Identify chronic medical conditions Identify detrimental lifestyle habits Physical examination: focus on breasts and circulatory problems Offer screening for fetal chromosomal abnormalities Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Chapter 10 Promoting a Healthy Pregnancy Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Planning for Pregnancy Preconception Periconception Interconception Preconception counseling Identify conditions that could adversely affect pregnancy Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families The Healthy Body Menstrual and medical history Exposure to childhood illnesses Exposure to STIs Exposures related to lifestyle choices Physical examination Laboratory evaluation Genetic testing Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley The Healthy Mind Readiness for motherhood Psychological changes during pregnancy The healthy relationship Readiness for fatherhood Support for life changes Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Nutrition and Weight Gain Nutritional elements Calories Protein Water Minerals and vitamins Iron Folic acid Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Weight Gain Affected by: Physiological factors Social influences Inadequate diet Inadequate physical activity Management Daily food and fluid intake Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Factors That Affect Nutrition Eating disorders PICA Anorexia nervosa, bulimia nervosa Cultural factors Vegetarian diets Food cravings and food aversions Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Exercise, Work, and Rest Exercise Muscle strengthening No rigorous aerobic activity Work Impact on pregnancy Maternity leave Rest Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Medications Safe versus teratogenic Over-the-counter Herbal and homeopathic preparations Prescription FDA pregnancy categories Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Common Discomforts Nausea and vomiting Ptyalism Fatigue Nasal congestion Backache Leukorrhea Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Common Discomforts (cont.) Urinary frequency Dyspepsia Flatulence Constipation/hemorrhoids Dental problems Leg cramps Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Common Discomforts (cont.) Dependent edema Varicosities Dyspareunia Nocturia Insomnia Round ligament pain Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Common Discomforts (cont.) Hyperventilation, shortness of breath Numbness/tingling in fingers Supine Hypotensive Syndrome Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Signs and Symptoms of Danger Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley First Trimester Severe, persistent vomiting Abdominal pain and vaginal bleeding Indicators of infection Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Second Trimester Maternal complications Preeclampsia Premature rupture of the membranes Preterm labor Fetal complications Decreased fundal height Absence of fetal movement after quickening Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Third Trimester Maternal complications Gestational diabetes Placenta previa Abruptio placentae Fetal complications Hypoxia Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Pregnancy Map Prenatal care map Timetable Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Childbirth Education Primary goal To promote a positive childbearing experience Topics Anatomy and physiology Comfort measures Labor and birth process Relaxation and pain management Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Childbirth Education—Methods Lamaze Empowerment Dispelling myths Controlled breathing, position, massage, relaxation Bradley Inward relaxation Normal breathing Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Other Methods Dick-Read HypnoBirthing LeBoyer method Odent method Birthing from within Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Finding Information on Childbirth Education Primary source—health care provider Online and at-home programs Parents need to ask questions about the class to determine if it fits their needs Factors related to personal values and beliefs Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley The Birth Plan Written information that identifies labor and birth preferences The choices Choosing a provider Choosing a location Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Chapter 11 Caring for the Woman Experiencing Complications During Pregnancy Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Early Pregnancy Complications Perinatal loss Ectopic pregnancy Gestational trophoblastic disease Signs/symptoms: vaginal bleeding, excessive nausea/vomiting, abdominal pain, size/date discrepancy Management: remove uterine contents Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Spontaneous Abortion Before 20 weeks of gestation Signs/symptoms: bleeding, cramping, abdominal pain, decreased symptoms of pregnancy Management: D & C Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Incompetent Cervix Painless dilation and cervical effacement Second trimester Management Cerclage Bedrest Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Hyperemesis Gravidarum Criteria: persistent vomiting, measure of acute starvation, and weight loss Management Rest Small frequent meals (dry, bland foods) High-protein snacks Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Hemorrhagic Disorders Placenta previa Signs/symptoms: painless vaginal bleeding Management: stabilization and fetal monitoring Abruptio placentae Signs/symptoms: third-trimester bleeding associated with severe abdominal pain Management: monitoring, delivery Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Preterm Labor Morbidity and mortality Subtle signs/symptoms Biochemical markers Management goals Inhibit/reduce contraction strength/frequency Optimize fetal status Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Premature Rupture of Membranes Signs/symptoms: gush/trickle of fluid from vagina Management factors Establish gestational age Ultrasound to assess fetus Assess for advanced labor, infection If advanced labor or infection, deliver fetus Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Hypertensive Disorders Classifications: Chronic Preeclampsia-eclampsia Chronic hypertension with superimposed preeclampsia Gestational/transient Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Preeclampsia Multisystem, vasopressive Disease of placenta SPASMS Morbidity and mortality Management Delivery of fetus only cure Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Nursing Assessments— Preeclampsia Identify hypertension Proteinuria Edema CNS alterations Eclampsia: seizures Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families HELLP Syndrome Complication of preeclampsia Treatment Improve platelets with FFP Delivery of fetus as soon as feasible Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Disseminated Intravascular Coagulopathy (DIC) External or internal bleeding Nursing care Meticulous maternal and fetal assessment Place indwelling catheter Oxygen—rebreathing mask Blood and blood products Emotional support Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Multiple Gestation High-risk pregnancy Morbidity and mortality Management Delivery at Level III facility Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Infections UTI Group B streptococcus TORCH STIs HIV and AIDS Tuberculosis Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Inflammatory Disease & Pregnancy Systemic lupus erythematosus (SLE) Increased risk of pregnancy complications Management Immunosuppression of SLE flare Careful fetal surveillance If flare-up during pregnancy, rapid implementation of treatment Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Hemoglobinopathies Sickle cell disease Promote good dietary habits Early detection of infection and treatment Prevent dehydration Prompt treatment of sickle cell crises Fetal surveillance Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Hemoglobinopathies Thalassemia Close maternal and fetal surveillance Rh0(D) isoimmunization Admininster RhoGAM to prevent ABO Coombs test Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Respiratory Complications Pneumonia Aggressive management Asthma Maternal and fetal risks Careful monitoring Adjustments in therapy Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Cystic Fibrosis Fetus at risk for uteroplacental insufficiency and IUGR Monitor nutritional status Early recognition and treatment of pulmonary infections Maternal and fetal surveillance Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Cardiovascular Disease Symptoms similar to normal pregnancy physiological changes Labor, birth, immediate postpartum period Lateral recumbent position Administer IV fluids with caution Invasive hemodynamic monitoring Medications Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Other Cardiovascular Disorders Mitral valve prolapse Pregnancy may alleviate murmur and symptoms Peripartum cardiomyopathy No history of cardiac disease Signs/symptoms: dyspnea, fatigue, peripheral/pulmonary edema Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Diabetes Mellitus Morbidity and mortality Screening and diagnosis Management Home blood glucose monitoring Adjust diet, medication, physical activity Ongoing maternal-fetal surveillance Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Thyroid Conditions Hyperthyroidism Signs/symptoms Depressed TSH and elevated free T4 Antithyroid medications Hypothyroidism Symptoms Elevated TSH and low to normal T3 and T4 Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Venous Thrombosis and Pulmonary Embolism Symptoms Diagnosis Doppler ultrasound Ventilation-perfusion (VQ) scan Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Psychiatric Complications Depression Bipolar disorder Anxiety disorders Eating disorders Substance addiction Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Antepartum Fetal Assessment Chorionic villus sampling PUBS Amniocentesis Amnioscopy or fetoscopy Ultrasonography Fetal kick counts Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Assessment of Fetal Well-Being (cont.) Doppler ultrasound Fetal biophysical profile Non-stress test Vibroacoustic stimulation Contraction stress test Electronic fetal heart rate monitoring Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Special Conditions and Circumstances that may Complicate Pregnancy Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Antenatal Bedrest Regular community health nurse home visits Involve various community resources Support groups Provide emotional support Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Other Special Conditions Adolescent Advanced age Trauma Cancer Obesity Disability Susan Ward Shelton Hisley