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13730674 Maternity Nursing Edited Royal Essay

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 Maternity Nursing

I. Basic Knowledge on Genetics and Obstetrics

1. DNA – Deoxyribonucleic Acid – carries genetic code
2. Chromosomes – threadlike structure of hereditary material known as the DNA 3. Normal amount of ejaculated sperm – 3 – 5 cc/ 1 teaspoon 4. Ovum is capable of being fertilized within 24 – 36 hours after ovulation. 5. Sperm 48 – 72 days viability

6. Reproductive cells divide by the process of MEIOSIS (haploid number) Spermatogenesis – process of maturation of sperm
Oogenesis – process of maturation of ovum
30 weeks AOG – 6 million immature ovum
@ birth – 1 million immature oocytes
@ puberty – 300 – 400 immature oocytes
@ 13 y/o – 300 – 400 mature oocytes
@ 23 y/o – 180 – 280 mature ovum
@ 33 y/o – 60 – 160 mature ovum
@ 36 y/o – 24 – 124 mature ovum
@46 y/o – 4 mature ovum
Gametogenesis – process of formation of two haploid into diploid 7. Age of reproductivity – 15 – 44 y/o childbearing age – 20 – 35 y/o High risk  35 y.o. With Risk  18 – 20; 30 – 35 8. Menstruation

Menstrual Cycle – beginning of menstruation to the beginning of the next menstruation Average menstrual cycle – 28 days
Average menstrual period – 5 days
Normal blood loss – 50 cc/ ¼ cup accompanied by FIBRINOLYSIS – prevents clot formation Related terminologies
Menarche – 1st menstruation
Dysmenorrhea – painful menstruation
Metrorrhagia – bleeding in between menstruation
Menorrhagia – Excessive bleeding during menstruation
Amenorrhea – absence of menstruation
Menopause – cessation of menstruation (Average Age- 51 y.o.) Tofu – has isoflavone – estrogen of plant that mimics the estrogen with a woman 9. Functions of Estrogen and Progestin
ESTROGEN – hormone of woman
Primary function
Responsible for the development of secondary characteristics in females inhibit production of FSH
Other function
Hypertrophy of the myometrium
Spinnbarkeit and Ferning Pattern (Billings Method)
Ductile structure of the breast
Osteoblastic bone activity (causes increased in height)
Early closure of the epiphysis of the bone
Sodium retention
Increased sexual desire
Responsible for vaginal lubrication
PROGESTERONE – Hormone of the mother
Primary function – prepares the endometrium for implantation making it thick and tortous Secondary Function – inhibit uterine contractibility
Others
Inhibit LH (hormone of ovulation) production
 GI motility
 Permeability of kidneys to lactose and dextrose causing + 1 sugar in urine Mammary gland development
 BBT
Mood swings

10. Menstrual Cycle
4 phases of menstrual cycle
1. Proliferative
2. Secretory
3. Ischemic
4. Menses

1. On the initial phase of menstruation, the estrogen level is , this level stimulates the hypothalamus to release GnRH/ FSHRF 2. GnRH/ FSHRF stimulates the anterior pituitary gland to release FSH FSH Function

Stimulate ovaries to release estrogen
Facilitate the growth of primary follicle to become
GRAAFIAN FOLLICE  structure that secretes large amount of estrogen that contain mature ovum 3. Proliferative Phase (estrogen)
Follicular Phase – responsible for the variation and irregularity of mense Postmenstrual Period – after menstruation
Preovulatory Phase – happen before menstruation
4. 13th day of menstruation, estrogen level is PEAK while progesterone is , these stimulates the hypothalamus to release GnRH/ LHRF 5. GnRH/ LHRF stimulates the Anterior Pituitary Gland to release LH Functions of LH

Stimulates the release of progesterone
Hormone for ovulation
6. 14th day estrogen level is  while progesterone level is  S/S
Rupture of the graafian follicle - OVULATION
Mittelschsmerz – slight abdominal pain lower right quadrant 7. 15th day, after ovulation day, graafian follicle starts to degenerate, estrogen level , progesterone , causing degeneration of the graafian follicle becoming yellowinsh known as CORPUS LUTEUM – secretes large amount of progesterone 8. Secretory Phase

Lutheal Phase (progesterone)
Postovulatory phase
Premenstrual Phase
9. 24th day – Corpus Albicans (whitish) corpus luteum degenerates and becomes white 10. 28th day – if no sperm united the ovum, the uterine begins to slough off to have the next menstruation Note:

if there is no fertilization, corpus luteum continues functioning Ovarian Cycle – from primary follicle – corpus albicans
Stages:
1 – 5 days – menses
6 – 14 – proliferative
15 – 26 – secretory
27 – 28 – ischemic

II. Wonders of Fertilization
a. Fertilization
1. Phonones – song of sperm
2. Capacitation – ability of sperm to release proteolytic enzyme and penetrate the ovum b. Stages of Fetal Growth and Development
1. Pre Embryonic Stage
I. Zygote  fertilized ovum (3 – 4 days travel, 4 days floating)> from fertilization II. Morula  mulberry-liked ball containing 16 – 50 cells III. Blastocyst  enlarging cell forming a cavity that later becomes the embryo covered by thropoblast which later becomes the placenta and membrane IV. Implantation  7 – 10 days after fertilization

Thropoblast – covering of blastocyst that become placenta
S/Sx of Implantation  Slight pain, Slight Vaginal Spotting 3 Processes
Apposition
Adhesion
Invasion
2. Embryonic Stage
Zygote – fertilization to 14 days
Embryo – 15th – 2 mos/ 8 weeks
Fetus – 2 mos to birth
c. Decidua – thickened endometrium, latin word for “falling off” 1. Basalis – located directly under the fetus where placenta developed 2. Caspularis – encapsulates the fetus
3. Vera – remaining portion of and endometrium
d. Chorionic Villi – 10 – 11 weeks
1. Chorionic Villi Sampling (CVS) – removal of tissue from the fetal postion of the developing placenta For genetic screening
Fetal limb defects, missing digits of toes
e. Cytothrophoblast – outer layer, LANGHAN’S LAYER, protect the fetus against syphilis (24 weeks/ 6 months) f. Synsitiotrophoblast – syncitial layer – responsible for hormone production 1. Amnion – inner most layer 2. Chorion

I. Umbilical cord (Funis) – whitish gray (50 – 60 cm)
Short  abruptio placenta, uterine inversion
Long  cord prolapse, cord coil
3 vessels (AVA) – Artery Vein Artery
Wharton’s Jelly – protects the umbilical cord
II. Amniotic fluid  bag of water  clear color, musty/mousy odor With crystallized forming pattern, slightly alkaline
500- 1000 cc Normal
Oligohydramnios – kidney malformation
Hydramnios – GIT , TEF/ TEA
Functions
Cushion the fetus against sudden blow or trauma
Maintains temperature
Facilitate muscuskeletal development
Prevents cord compression
Helps in development process

Diagnostic Test for Amniotic Fluid  Amniocentesis
Purpose: obtain sample of amniotic fluid by inserting a needle hrough the abdomen into the amniotic sac Fluid is tested for:
Genetic screening
Determination of fetal maturity primarily by evaluating factors indicative of lung maturity Done with empty bladder
Complication
> Most common side effect : INFECTION
> Late : pre term labor
> Early : spontaneous abortion
Indication for Amniocentesis:
> Early in Pregnancy Advance Maternal Age
> Later in Pregnancy Diabetic Mothers
 - down syndrome
 - neural tube defect, spina befida
L/S ratio : 2:1 (Lecitin/ Spingomyelin)
Definitive test = Phosphatiglycerol: PG +  best Answer
Greenish – Meconium Stains (Fetal Distress)
Yellowish – jaundice, hyperbilirubinemia
Cloudy – Infection
Most Important Consideration  Needle insertion site
Amnioscopy – direct examination through intact fetal membrane via ultrasound Fern Test – a test determining if bag of water has rupture or not Nitrazine Paper Test – differentiate amniotic fluid and urine Blue geen  + rupture of bag of H2O

2. Chorion – outermost layer
a. Placenta – AKA Secundines  chorionic Villi and basalis Pancake in latin
500 grams in weight
15 – 28 cotyledons
15 – 20 cm in diameter and 2 – 3 cm in depth
Functions
Respiratory  02 – CO2 exchange via simple diffusion
GIT  glucose transport via facilitated diffusion
Excretory  via 2 arteries, carries unoxygenated blood then detoxify by maternal liver Circulatory  fetoplacental circulation by SELECTIVE OSMOSIS Endocrine
HCG – primary maintain corpus luteum/ secondary basis of pregnancy test Human Placental Lactogen – aka Somatomammothrophin
Responsible for the development of mammary gland
Diabetogenic Effect – insulin antagonist
Relaxin – softening of maternal joints and bones
Serves as protective barrier against some microorganism
Can pass: HIV CMV Rubella
PINOCYTOSIS – transport of virus

Pregnancy – 266 – 288 days/ 37 – 42 weeks

FETAL STAGE: Fetal Growth and Development

First Trimester : Period of organogenesis, most critical period
First Month
FHT, CNS Develops, GIT and Respi Tract remains as single tube
Differentiation of Primary Germ Layer
Endoderm
Thyroid – responsible for basal metabolism
Thymus – immunity
Liver
GIT
Linings of Upper GI Tract
Mesoderm
Heart
Musculoskeletal
Reproductive Organ
Kidney
Ectoderm
Brain
CNS
Skin
5 senses
Hair, nails
Anus
Mouth
Second Month
Life span of corpus luteum ends
All vital organs are formed
Placenta is developed
Sex organ is developed
Meconium is present
Third Month
Placenta is complete
Kidneys are functional
Fetus begins to swallow amniotic fluid
Buds of milk appear
Sex is distinguishable
FHT audible via dopples @ 10 – 12 weeks
Terratogens – any drug or irradiation, the exposure to which may cause damage to the fetus DRUGS
Streptomycin – anti – TB – (quinine) damage to the 8th cranial nerve  poor learning and deafness/ ototoxic Tetracycline – stoning the tooth enamel, inhibits long bone growth Vitamin K – hemolysis, destruction of RBC, jaundice, hyperbilirubenemia Iodides – enlargement of thyroid and goiter

Thalidomides – anti-emetics  Amelia or Pocomelia  absence of distal part of extremities Steroids – cleft lip or palate and even abortion
Lithium – congenital maformation
ALCOHOL – LBW, fetal alcohol syndrome ( characterized by microcephaly) SMOKING – LBW
CAFFEINE – LBW
COCCAINE – LBW, abruptio placenta
TORCH – group of infections that can cross the placenta or ascend through the birth canal and adversely effect fetal growth Toxoplasmosis – cat lovers
Others - Hepa AB, HIV, Syphillis
Rubella – CHD,
Rubella Titer – N @ 1:10 or  = immunity to rubella = notify doctor Rubella vaccine after delivery for 3 mos. No pregnancy for 3 mos. Cytomegalo virus
Herpes Simplex virus

Second Trimester : continuous growth and development (focus  lengh of fetus)
Fourth Month
Lanugo begins to appear
Buds of permanent teeth appear
FHT audible via Fetuscope @ 18 – 20 weeks
Fifth Month
Quickening : 1st fetal movement Primi: 18 – 20, Nulli - 16 - 18 Lanugo covers the body
FHT audible via stethoscope or w/out instrument
Actively swallow amniotic fluid
Fetus : 19 – 25 cm
Sixth Month
Skin is red and wrinkled
Vernix caseosa covers the skin
Eyelids open
Exhibits startle reflex
3rd Trimester : period of most rapid growth and development Focus: weight Seventh Month
Surfactant development
Male: the testes begins to descent into the scrotal sac
Female : clitoris is prominent and labia majora are small doesn’t cover the minora Eight Month
Active moro reflex
Lanugo begins to disappear
Sub q fats deposits, steady weight gain, nails to fingers
Ninth Month
Lanugos and vernix caseosa is evident in body fold
Birth position assumed
Amniotic fluid somewhat decrease
Sole of the foot has few creases
Tenth Month
Bone ossification in the fetal skull
Vernix caseosa is evident in body

PHYSIOLOGIC ADAPTATION TO PREGNANCY

Systemic Changes
1. Cardiovascular System
 blood volume 30 – 50%
1500 cc; additional 500 cc for multiple pregnancy
 plasma volume
 cardiac workload – easy fatigability/ slight ventricular hypertrophy Epistaxis due to hyperemia of nasal membrane
Palpitation due to SNS stimulation
Physiologic Anemia/ pseudoanemia in pregnacy
Normal Value
Hct : 32 – 42%
Hgb: 10.5 – 14 g/dl
Criteria
1st & 3rd Trimester : Hct > 33% Hgb > 11 g/dl
2nd Trimester : Hct > 32% Hgb > 10.5 g/dl
Pathologic Anemia
Iron Defficiency Anemia is the most common hematologic disorder. It affects 20% of pregnant women Assesment reveals:
Pallor
Slowed capillary refill = Normal = 2 – 3 sec
Concave fingernails (late sign of progressive anemia) – clubbing = chronic tissue hypoxia constipation
Nursing care
Nutritional instruction
Source of iron
Kangkong
Liver = best source due to FERRIDIN Content
Red and lean meat
Green Leafy Vegetables
Parenteral Iron (Imferon)
Z tract IM
incorrect causes hematoma
best given 1 hour before meals (causes GI irritation)
Maybe given 2 hours after meal (results to poor absorption) Given with orange juice to  absorption
Oral Iron Supplements (ferrous sulfate 0.3 g 3 x a day)
Monitor for hemorrhage
Alert
Iron from red meat is better absorbed iron from other sources Iron is better absorbed when taken with foods high in Vitamin C such as orange juice Higher iron intake is recommended since circulating blood volume is increased and heme is required from production of RBCs Edema

Impeded venous return due to the gravid uterus
Nursing Intervention
Elevate legs above the hips level
Varicosities
Wear support stockings
Elevate legs
Vulvar Varicosities
D/t pressure of gravid uterus
Side –lying with pillow under the hips
Modified knee – chest position
Thrombophlebitis
Presence of thrombus in inflamed blood vessels
+ Homan’s Sign – pain on the calf upon dorsiflexion
Medical Management
Anticoagulant/ HEPARIN
Does not cross the placental barrier
Monitor APTT
Antidote: PROTAMINE SULFATE
No aspirin
Milk Leg/ Plagmasia Alba Dolens
Shiny white legs due to stretching of skin & hyperfibrinogenemia Nursing intervention
Check dorsalis pedis pulse (compare both)
Never massage
Assess for Homan’s sign only onc...

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tone tongu tooth torch tortous touch towel toxemia toxic toxoplasmosi tract traction transfer transfus transit transport transvagin transvers trash trauma travel treat tremor trendelenberg trendelenburg tri triad trial triangular trichomona trigger trigon trimest trophoblast true trush tsb tt1 tt2 tt3 tt4 tt5 tubal tube tuberoischii tuberos turn twentieth twice two tx type u ulrasound ultrasound umbil umbilicus umusu unabl undeni undergo underwt uneven unilater unit univers unknown unoxygen unruptur unsaf unsuucess upon uppe4r upper urethroan urin urinari use user usual uterin uterus uti util v v/s vaccin vacuum vagin vagina vaginali vaginoplasti vagu valsalva valu variabl variat varicos varieti vas vasectomi veal veget vegetarian vein vena venous ventricular vera vernix vertex vertic vesicl vessel vi via viabil viabl vigor vii villi vinegar violet virgin virus visit vission visual vit vital vitamin void volum voluntari vomit vs vulvar w w/o w/out waddl waist wait wake walk wall want 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