MATERNAL and CHILD NURSING

I. Reproductive Anatomy and Physiology A. Anatomy of the Female Genital Tract 1. External Structures a. mons veneris b. labia majora c. labia minora d. clitoris homologue of the penis e. vestibule f. urethral meatus g. paraurethral glands h. hymen i. perineum j. fourchette

2. Internal Structures a. vagina = passageway for sperm and menses; organ for copulation b. uterus parts: cervix, isthmus, corpus and fundus layers: perimetrium, myometrium, endometrium normal position: anteflexed and anteverted

c. ligaments (1) broad ligament most important uterine transverse ligament (2) round ligament (3) uterosacral ligaments d. infundibulum e. ovaries = produces estrogen and progesterone

B. Anatomy of the Male Genital Tract 1. Functions a. reproductive production of spermatozoa b. endocrine production of testosterone 2. Component organs a. testes b. prostate gland } accessory gland c. seminal vesicle } of the male reproductive tract d. penis

3. Spermatic Cord a. structures within the cord vas deferens testicular vessels testicular lymphatics autonomic nerves remains of the processus vaginalis

C. The Menstrual Cycle = cyclic monthly changes in ovaries and endometrium preparation for ovulation = normal cycle is 25-35 days; average of 28 days = menstruation monthly shedding off of uterine lining in response to drop in estrogen and progesterone level average of blood lost: 70 ml.

= menarche onset of menstruation between 12-16 years of age = ovulation taken by counting 14 days backward from 1st day of menstruation = menopause permanent cessation of menstrual flow between 45-50 years of age

Effects of Estrogen: responsible for breast and uterine development genital enlargement softens connective tissue decreases HCL and pepsin antagonist to insulin support fat deposition Na and water retention vasodilation increase production of MSH

Effects of Progesterone: development of decidua promotes relaxation of uterine muscles favors fat deposition decrease gastric motility and relaxes sphincters decreased smooth muscle tone increase basal body temperature

The Menstrual Cycle is divided into 3 events: the hormonal cycle the ovarian cycle the uterine cycle

A. The Hormonal Cycle hypothalamus secretes GnRH GnRH, in turn, stimulates FSH FSH stimulates the ovarian follicle to mature The anterior pituitary secretes LH LH causes final maturation of the graafian follicle, ovulation and formation of the corpus luteum

B. The Ovarian Cycle Phase 1 : The Follicular Phase graafian follicle matures in response to FSH in a 28 day cycle, this phase lasts for 14 days ovulation and rupture of the graafian follicle occurs 14 days before the onset of the next menses

Phase 2 : The Luteal Phase this phase lasts 14 days regardless of the average length of the cycle begins following ovulation corpus luteum begins to degenerate at 1 week after ovulaiton

C. The Uterine Cycle Phase 1 : The Menstruation Phase degenerated protion of the endometrium is shed estrogen levels are low

Phase 2 : The Proliferative Phase endometrium proliferates under inc. estrogen production endometrium increases in thickness glands become larger, long and more tortuous blood vessels dilate and become more prominent lasts 6-14 days

Phase 3 : The Secretory Phase begins following ovulation endometrium becomes secretory progesterone is the hormone produced by corpus luteum initiating secretory changes

Phase 4 : The Ischemic Phase occurs 27-28 days into 28 day cycle corpus luteum degenerates estrogen and progesterone secretion falls necrosis of parts of the endometrium menstrual flow begins

II. Fetal Development A. Fertilization union of sperm and ovum Sperm = male gamete = process of maturation: SPERMATOGENESIS = life span after ejaculation: 72 hours Ovum = female gamete = process of maturation: OOGENESIS = life span after ovulation: 12-24 hours = one ovum is released every month

 maturation of gamete: gametogenesis product of union of sperm & ovum is ZYGOTE after implantation, the endometrium is now DECIDUA 3 parts of deciduas: basalis, capsularis and vera

3 Stages of Human Prenatal Development 1. Ovum period of fertilization until primary villi appears 12-14 days of gestation 2. Embryo 54-56 days of gestation

 period of rapid cell division most critical time for development of individual highly vulnerable to teratogens, virus, radiation 3. Fetus from embryonic stage till pregnancy is terminated

B. Development of the Placenta develops from the union of chorionic villi and deciduas basalis 2 Surfaces 1. Maternal surface 2. Fetal surface covered by 2 membranes 1. amnion 2. chorion

Functions of Placenta

nutritive respiratory excretory endocrine (HCG, progesterone, estrogen, HPL)

C. Amniotic Fluid clear pale straw fluid in which the fetus floats quantity: 500-1500 ml. Polyhydramnios-fluid more than 1,500ml Oligohydramnios- fluid less than 300 ml Green tinged-presence of meconium

Functions of Amniotic Fluid protects fetus from direct trauma separate fetus from fetal membrane allow freedom of fetal movement facilitate growth and development protect fetus from heat loss source of oral fluid as excretion or collection system

D. Umbilical Cord extends from fetal umbilicus to the fetal surface of placenta cord carries 2 arteries and 1 vein ave.length is 56cm funic souffl-synchronous with fetus uterine souffl-synchronous with maternal pulse

E. Growth and Development of the Fetus cephalocaudal development 1st trimester-period of organogenesis 2nd trimester-period of rapid increase in length 3rd trimester-period of continuous growth and rapid devt due to subcutaneous fat deposition 1. Primary Germ Layers a. ectoderm b. endoderm c. mesoderm

2. Development of the Major Body Systems a. cardiovascular system = begins to form 16 days of life = beat as early as 24 days = FHT: 120-160 bpm b. fetal circulation = established at 3rd week of intrauterine life

c. respiratory system = 3rd week of life, respiratory and digestive tract exist as a single tube = end of 4th week, septum begins to divie the 2 systems =alveoli begin to form between 24-28th weeks =at 24th weeks, surfactant is excreted by alveolar cells =surfactant contain lecithin and sphinomyelin = normal L/S ratio 2:1

3. Development of Fetus per Lunar Month 1st Lunar Month does not appear human heart appears as bulge on anterior surface 2nd Lunar Month organogenesis is complete heart is beating facial features are discernible external genitalia present but not distinguishable

3rd Lunar Month ossification centers forming at the bones, tooth buds male and female distinguishable 4th Lunar Month FHT can be heard Lanugo is forming 5th Lunar Month quickening occurs

6th Lunar Month passive antibody transfer occurs vernix caseosa forms production of lung surfactant begins 7th Lunar Month surfactant found in amniotic fluid 8th Lunar Month subcutaneous fat begin to deposit assumes delivery position

9th Lunar Month stores glycogen iron deposited testes descend 10th Lunar Month ready for labor

III. The Pregnant Patient series of events resulting to birth of the fetus and products of conception from the mothers womb
A. Factors affecting labor pelvic dimension fetal dimension uterine contractions

B. Preliminary Signs of Labor lightening increased vaginal secretions weight loss of 1-3 lbs sudden burst of energy cervix becomes soft and effaced membranes may rupture frequent Braxton Hicks contractions backache may increase diarrhea may occur bloody show

C. Stages of Labor 1. 1st stage of labor stage of cervical dilatation begins with true labor ends with complete cervical dilatation
2. 2nd stage of labor stage of expulsion begins with full cervical dilatation ends with expulsion of fetus

3. 3rd stage of labor placental stage begins with expulsion of the fetus ends with delivery of the placenta 4. 4th stage of labor vigilant stage from delivery of placents to an hour post partum

D. Phases of Labor 1. Latent Phase early phase dilates from 0-4cm contractions mild patient excited thoughts centerd self, labor and baby talkative or mute, calm or tense pain controlled fairly well alert, follows directions

2. Active Phase accelerated phase dilates 4-7cm contractions mild to moderate more comprehensive, more serious doubtful of pain control desires companionship and encouragement has some difficulty following instructions

3. Transitional Phase declaration phase dilates 0-10cm contractions moderate to strong backache common fear of loss of control irritable amnesia between contractions hyperventilating perspiration on forehead shking, tremor of thighs feeling of need to defecate

F. Mechanism of Labor engagement descent flexion internal rotation extension external rotation expulsion

G. Breathing Techniques used for relaxation in the early phases of labor breathing technique depends of degree of cervical dilatation 1. dilatation to 3cm cleansing breath keep breathing slow and rhythmic when contraction ends, take one deep breath

2. dilatation to 4-7cm cleansing breath at the beginning of each contraction breathing now more shallow encourage slow, abdominal breathing 3. dilatation of 8-10cm cleansing breath maintain concentration on breathing encourage use of 4:1 breathing pattern: breath, breath, breath and puff panting breath are encouraged

H. Breastfeeding transfer of antibodies fewer allergic reactions lesss diarrhea and constipation maternal organs heal faster
1. Client need health promotion maintenance

2. Patient Teachings line bra with soft cotton to avoid leakage avoid using harsh cleansers on nipples let nipples dry for 5-15 mins use breast pump for storage of milk wash breasts with water use well fitting supportive bra well balanced diet colostrums will be secreted initially milk appears 48-96 hours after delivery burp after each feeding mothers fluid intake: 3,000ml/day

I. Nutrition 1. Calories daily caloric increase of 300kcal throughout pregnancy recommended 2. Proteins increased requirement to meet the demands of the growing fetus,and placenta milk and milk products: ideal sources 3. Iron needed supplement in latter half of pregnancy requirement: 7mg/day

4. Calcium majority of maternal calcium: in bones 5. Zinc severe deficiency may lead to poor appetite and impaired wound healing (maternal); dwarfism and hypogonadism (fetus) 6. Iodine severe maternal iodine deficiency result in fetal endemic cretinism

7. Potassium prolonged nausea and vomiting may lead to hypokalemia and metabolic acidosis 8. Vitamins can be supplied by general diet 9. Folic Acid supplemented to avoid risk of neural tube defects 10. Vit. A teratogenic not given during pregnancy

J. General Hygiene 1. Exercise no need to limit exercise aerobic exercise walking is the best exercise 2. Employment with risk of preterm delivery for jobs that require prolonged standing severe physical strain should be avoided

3. Travel no harmful effect on pregnancy airline travel allowed 4. Bathing caution in taking tub bath, might slip 5. Clothing practical and non constricting well supporting brassiers

6. Bowel Habits constipation is common greater frequency of hemorrhoids prevented by sufficient fluids and daily exercise 7. Coitus no harm before the last 4 weeks of pregnancy 8. Smoking adverse effects on fetus: decrease birth weight, premature birth, fetal limb deficiencies extensive placental calcification is doubled

9. Alcohol pregnant should abstain 10. Caffeine potentiates mutagenic effects of radiation and some chemicals 11. Illicit Drugs opium derivatives, barbiturates, amphetamines are harmful to fetus fetal distree and low birth weight infants

Common Complaints 1. Nausea and vomiting associated with high levels of HCG in H. mole, nausea and vomiting more pronounced Complications: dehydration, electrolyte imbalance and starvation require hospitalization advise small frequent feedings. Dry crackers in the morning

2. Backache
squat when reaching down back support with pillows avoid high heeled shoes may give analgesia, heat and rest

3. Varicosities
exaggerated by prolonged standing, pregnancy and advancing age noted by cosmetic blemishes on lower extremities, mild discomfort at the end of the day treatment with elevated legs and nonconstrictive elastic stockings

4. Hemorrhoids
due to increased pressure in the rectal veins relieved by prescribed stool softeners, warm soaks, topical anesthetics

5. Heartburn
caused by reflux of gastric contents into lower esophagus upward displacement of stomach by uterus relaxation of lower esophageal sphincter secondary to progesterone Advise to eat small frequent meals

6. Pica
bizarre craving for food Patient is at risk for anemia

7. Fatigue
early in pregnancy relieved during the fourth month

8. Headache
due to ocular strain treatment is symptomatic majority has no cause

IV. Antepartal Nursing Care A. Terminology 1. Primipara

woman delivered only once of a fetus reaching viability

2. Nullipara
woman who has never completed pregnancy beyond abortion

3. Multipara
woman who has completed 2 or more pregnancies to viability

4. Nulligravida
woman who is not now or has been pregnant

5. Gravida
woman who is or has been pregnant irrespective of outcome

6. Parturient
woman in labor

7. Puerpera
woman who has just given birth

B. 4 digit OB history FT-P-A-L

1st digit = number of term infants 2nd digit = number of preterm infants 3rd digit = number of abortions 4th digit = number of living childre

C. Mean duration of pregnancy

280 days 40 weeks

D. Naegeles Rule
Expected date of confinement EDC Date on the 1st day of LMP plus 7 days Count back 3 months

E. Trimesters of Pregnancy
1st tri = completion of 14 weeks 2nd tri = through 28 weeks 3rd tri = includes 29th to 40th week

F. Diagnosis of Pregnancy 1. Presumptive Symptoms Nausea and vomiting

appears at 6th week peaks about 60-70 days persistent vomiting may lead to dehydration requiring hospitalization (hyperemesis gravidarum) mgt: small frequent feedings, avoidance of fatty foods, ice chips, dry crackers emotional support from family

Disturbance in urination
Enlarging uterus causes direct pressure on urinary bladder Most marked during 2nd and 3rd months

Fatigue
lassitude and easy fatigability during 1st trimester Frequent rest periods

Perception of fetal movement

Slight flutter or brisk movement 18th-20th week = primigravida 14th-16th week = multigravida

Breast symptoms
The Effect of estrogen Breast tenderness or mastodynia

Cessation of menstruation
One of the earliest signs of pregnancy Delay of 10 days or more strongly suspect pregnancy However, amenorrhea not a reliable indicator

Anatomical breast changes

Caused by hormonal stimulation Areola becomes larger and more prominent

Changes in vaginal mucosa: Chadwicks sign Skin pigmentation

Chloasma Linea nigra Striae gravidarum Spider telangiectasia Palmar erythema

Thermal signs
elevate body temp for more than 3wks effect of progesterone

Probable Evidence Abdominal enlargement

Progressive enlargement from 6th wk to term Fundic height correlate with AOG: 16-32 weeks

Uterine changes
changes in size, shape, consistency

Cervical changes
softening of the cervix at 6-8 weeks cervical mucus: beaded cellular pattern

Probable Braxton Hicks

painless irregular contractions

Ballotement
feeling that something is floating or bouncing inside

Outlining the fetus

Feel or palpate the parts of the fetus

Endocrine test or pregnancy test

HCG in the urine is the basis

4. Positive Signs Identification of FHT

Normal rate: 120-160 bpm Distinguished from mothers own pulse Other sounds heard: funic souffl, uterine souffl, maternal pulse, gurgling gas

Perception of fetal movement by examiner Recognition of fetus by UTZ

at 6-12 wks, CRL predictive of gestational age

G. Pseudocyesis
Imaginary or spurious pregnancy Women who strongly desire pregnancy Patient may actually feel signs and symptoms of pregnancy

H. Body Changes a. uterus hypertrophy and hyperplasia level of symphysis pubis at 12th week level of umbilicus at 20th week level of xiphoid at 36th week b. cervix Goodells sign Darkens in color Hegars sign

c. vagina Chadwicks sign Leukorrhea prone to candidiasis

d. ovaries ovulation stops e. skin changes striae gravidarum diastasis recti

umbilicus protrudes linea nigra melasma or chloasma spider telangiectasia

f. breast changes enlargement firm and tender darkening of areola appearance of colostrums

I. Physiologic Changes a. circulatory system increase in blood volume pseudoanemia blood pressure changes b. gastrointestinal system stomach and intestine displaced nausea hyperptyalism c. urinary system urinary output gradually increases ureters increase in diameter frequency of micturition

d. skeletal system calcium and phosphorous pride of pregnancy (lordosis in pregnancy) e. endocrine system placenta as an endocrine organ increased production of growth hormone and MSH oxytocin produced in late pregnancy f. metabolism glucose levels fluid retention effect by estrogen and progesterone

g. immunologic IgG production is decreased Increase WBC h. nervous system mild depression craving for indigestible foods i. weight gain total weight gain: 24 lbs 2 lbs = 1st tri 11 lbs = 2nd tri 11 lbs = 3rd tri

V. Intrapartal Assessment A. Induction of Labor to artificially initiate or augment uterine contractions with administration of oxytocics 1. Preparation to administer oxytocin 1000ml of D5W or D5LRS

2. Maintain dose if contractions last for 40-60 seconds 3. position patient left lateral decubitus
4. monitor fetus heart rate movement

5. monitor mother blood pressure, esp hypotension pulse uterine contractions uterine tone input and output nausea, vomiting headache

6. d/c oxytocin IU pressure ia above 75mm Hg Duration of contractions over 90 secs fetal tachycardia fetal bradycardia irregular FHT 7. client need safe and effective environment

B. Leopolds Maneuver performed during latter parts of pregnancy

1. First Maneuver LM 1 fundal grip what fetal pole occupies the fundus? Breech: large nodular body cephalic: hard, round, freely movable

2. Second Maneuver LM 2 umbilical grip which side is the fetal back? Back: hard resistant structure fetal parts: numerous nodulations

3. Third Maneuver LM 3 pawliks grip which fetal part lies above the pelvic inlet?
4. Fourth Maneuver LM 4 pelvic grip which side is the cephalic prominence? Confirms findings of third maneuver

C. Management During the First Stage of Labor 1. Admission 2. Assessment / Careful Evaluation of: EDC Genetic and familial problems Medical disorders, allergies Health problems Post obstetric history Pelvic measurements Height Weight gain Lab results, blood type, urinalysis

3. Admission Findings emotional status vital signs hundic height present fetal sixe edema urinalysis

4. Fetal heart rate normal: 120-160 bpm bradycardia: 100-119 bpm tachycardia: 160-179 bpm initial action: reposition mother on her side 5. Contractions monitor every 15-30 minutes duration interval frequency intensity

6. Monitor Maternal Vital Signs pulse and respirations blood pressure TPR VS should be taken & recorded prior to and after analgesia

7. Nursing Action reposition on her side oxygen by mask increase flow IVF notify the physician 8. Labor progress effacement dilatation station bulging perineum

9. Health Teachings comfort promoted physical needs emotional support analgesia and anesthesia support and reinforce Lamaze technique watch for signs that 2nd stage is near

10. Contraindicatins to progress of labor head not engaged malpresentation premature labor placenta or abruptio placenta

D. Management During the Second Stage patient encouraged to push breathing and relaxation techniques primigravid to DR: caput at introitus multigravid to DR: cervix 10cm, station at +2 patient in dorsal lithotomy position

apply episiotomy Modified Ritgens maneuver baby out secretions suctioned cord clamped

E. Immediate Care of the Neonate ensure clear airway maintain warmth corrd tied close to umbilicus APGAR score identification of neonate Vit. K administration

F. Management of the Third Stage goal: prompt separation and recovery of placenta achieved in easiest and safest way normal placental separation: 5-7 mins initial action inform physician check placenta check contracted fundus check perineum check bladder vulva is cleansed

G. Signs of placental separation firm, contracting fundus globular shaped abdomen sudden gush of blood lengthening of the cord vaginal fullness H. Mechanism of placental extrusion Schultz Duncan

VI. Postpartal Nursing Care A. Lochia discharged debris by uterus following delivery lochia rubra lochia serosa lochia alba 1. Assessment of Lochia amount of discharge odor, if present color of discharge clots, if present

2. Client Need health promotion and maintenance 3. Nursing Interventions alert physician if large clots are present count number of pads 4. Patient Teaching instruct patient on what to expect tell px to call physician if lochia varies from normal

B. Postpartum Depression adaptive behavior and self care 1. Assessment external os closed VS return to baseline constipation resolved linea nigra fading urinary elimination unaltered uterus not palpable

breast engorgement weight loss of 16-24 lbs caesarean section lochia alba episiotomy healing

2. Client Need health promotion and maintenance

3. Nursing intervention evaluate diet encourage increased nutritional intake offer emotional support
4. Patient Teaching instruct on lochia flow may resume intercourse when episiotomy healed postpartum exercise use birth control

C. Postpartum Depression feeling of let down & hopelessness 1st 2 weeks following delivery related to shifts in hormones 1. Assessment anorexia crying spells

insomnia support system irritability mood swings anger fatigue

2. Client Need psychological integrity

3. Patient Education adequate rest and nutrition support from family avoid overstimulation

VII. Newborn Assessment A. Physical Assessment 1. posture 2. body/muscle tone 3. Moro reflex 4. vital signs temperature heart rate respiratory rate

5. vital statistics weight length head circumference abdominal circumference chest circumference 6. skin color lanugo turgor

7. head molding anterior fontanelle posterior fontanelle hair face eyes mouth nose milia ears head lag

8. neck mobility thyroid gland lymph nodes clavicles control reflex 9. chest shape expansion auscultation breast

10. abdomen shape umbilicus femoral pulse 11. genitalia urination vagina penis scrotum

12. back and anus buttocks spine alignment sacrum anus 13. extremities arma hands legs feet

B. APGAR Score parameters: heart rate, respiraton, muscle tone, reflex, irritability, and color maximum score: 10 usual score at 1 min.: 8-9 usual score at 5 mins.: 9-10 score of 4-7: respiratory depression

VIII. Complications of Labor A. Dystocia painful, difficult, prolonged labor problems with: passenger, passageway, power
1. Assessment contractions drop in intensity progress of labor vaginal exam

contractions drop in frequency uterus tense fetal position abdominal palpation

2. Most common malposition right occipitoposterior left occipitoposterior

3. Condition of fetus myelomeningocoele face presentation hydrocephalus FHT Breech most common 4. Condition of mother full bladder ovarian tumor leiomyomas

5. Variations from normal time of contractions possibility of placenta previa centimeters dilated strength of contractions
6. Nursing intervention analgesia

7. Patient Teaching childbirth preparation ambulation adequate hydration sedation adequate rest CS may be required

B. Hemorrhage blood loss > 500ml 1. Assessment uterine atony lacerations retained placent lack of blood coagulation

2. Predisposing Conditions forceps delivery grand multiparity baby over 9 lbs induced labor trauma maternal malnutrition
3. Client need health promotion and maintenance

4. Intervention for uterine atony weigh pads administer oxygen blood typing give oxytocin massage uterus inspect for lacerations administer blood products

5. Intervention for retained placenta manual removal of placenta 6. Patient Teaching report temperature report large clots instruct how to massage

C. Premature Delivery born before 37th week of gestation premature commonly weighs < 2500 gms at high risk for problems
1. Maternal Association placenta previa hypertensive disease abruptio placenta

2. Fetal Association pneumothorax RDS 3. Maternal Assessment PROM Uterine anomalies Gestational DM Hemorrhage Infection

4. Fetal Assessment urine output gestational age infections vernix caseosa respiratory distress fonatel weight APGAR score Multiple gestation

5. Client Need physiological integrity 6. Nursing Interventions keep infant warm maintain clear airway rub back or soles transport to special care facility avoid handling infant more than necessary

IX. Complications of Pregnancy A. Pregnancy induced Hypertension most common hypertensive disorder of pregnancy char.: increase BP, proteinuria, edema systolic BP of 30mmHG and diastolic BP of 15mmHg above baseline cause: unknown only cure: delivery of the fetus

1. Assessment increase inBP generalized edema weight gain: > 1 lb/wk 3rd tri. protein of +1 2. High risk patients black primigravidas

 primi with twis adolescents in low socioeconomic status women over 35 y/o Rh incompatibility DM History of H. mole

3. Severe preeclampsia headache blurred vision spots before eyes pulmonary edema dyspnea

4. Eclampsia temp 101 F facial twitching grand mal seizures apnea staring, dilated pupils coma
5. Client need physiological integrity

6. Nursing intervention high protein diet bedrest administer magnesium sulfate Calcium carbonate: antidote for magsulfate Monitor FHT Daily weight Monitor DTR Monitor LOC Left lateral decubitus position Monitor fetal movement

 Diazepam: as sedative Hydralazine: as antihypertensive Strict I & O Monitor breath sounds Observe vaginal bleeding
7. Nursing teachings emergency situation fetal status

B. Ectopic Pregnancy gestation outside the uterine cavity most frequent site: ampullary portion of FT
1. Unruptured Ectopic pregnancy missed period early symptoms of pregnancy abdominal pain 3-5 weeks scant, dark brown vaginal discharge pregnancy test (+)

2. Tubal rupture syncope use of IUD abdominal crampng shoulder pain severe pain use of OCP signs of hypovolemic shock 3. History of: smoking venereal disease PID Endometriosis

4. Client need physiological integrity 5. Nursing action vital signs IV fluids Vaginal bleeding Strict I & O

6. Nursing action if for surgery antibiotics perineal pads bowel sounds early ambulation monitor surgical site 7. patient teaching blood transfusion about ectopic pregnancy

C. Hydatidiform mole gestatonal anomaly of placenta bunch of clear vesicles formed from swelling of chorionic villi result of fertilized egg with lost nuleus 1. Early signs/symptoms like normal pregnancy vesicles passed through vagina hyperemesis gravidarum fundic height vaginal bleeding

2. Early in pregnancy high levels of HCG preeclampsia at 12weeks

3. Later signs/symptoms hypertension before 20wk snowstorm appearance on UTZ anemia abdominal cramping

4. Nursing intervention D&C NO oxytocics

5. Patient education low probability of another H.mole pregnancy D&C: effective method of removing H. mole Avoid pregnancy for 1 year

D. Hyperemesis Gravidarum exaggerated nausea and vomiting in pregnancy fluid and electrolyte imbalance cause: unknown related to high levels of HCG

1. Assessment electrolyte imbalance hypovolemia increase pulse rate jaundice hemorrhage dehydration hypotension nausea weight loss

2. Nursing intervention IV fluids I&O Oral intake Phenergan IM NPO

3. Patient teaching oral intake slowly

E. Placenta Previa placenta is improperly implanted in lower uterine segment cause: unknown
1. Assessment bright red bleeding fetal distress engagement hypovolemic shock

2. Nursing action bedrest prepare for CS vital signs blood type and crossmatch IV fluids
3. Client need physiological integrity

F. Abruptio Placenta premature separation of placenta occurs after 20th weeks gestation hemorrhage cause: unknown

1. Assessment dark red vaginal bleeding severe abdominal pain hypovolemic shock hypertonic uterus portwine amniotic fluid concealed bleeding oliguria fetal distress

2. Complications DIC Fetal hypoxia Renal failure Hypovolemic shock High risk pregnancy
3. Nursing intervention IV fluids FHT

Type and crossmatch Foley catheter Vital signs I&O Hemoglobin level

4. Patient teaching emergency situation

G. Iron Deficiency Anemia most common hematologic disorder in pregnancy 1. Assessment pallor slow capillary refill nutrition 1st tri: Hgb < 11 g.dl 2nd tri: Hgb < 10.5 g/dl 3rd tri: Hgb < 10 g/dl

2. Nursing intervention nutritional instruction Ferrous sulfate Parenteral iron

3. Patient teaching iron from red meat higher iron intake during pregnancy iron better absorbed with Vit. C foods rich in iron

THE END