回顾母婴护理-母婴护理-护理学

ReviewofMaternal-InfantNursing,徐丽华上海交通大学护理学院2006427,TrendsinMaternal-InfantNursingCare,Developmentstandardofcare,certification,advancedpracticenursesHomeHealthcareforpostpartumwomen,dischargefromHops.12-24hoursafterdelivery,highriskinfantsdischargehomeearlierthanbeforeConsumerinvolvedinthechildbearingcare:Childbirthclass,siblingpresent,breast-feeding,birthingenvironment(LDR,LDRP),fathersinvolvement,parentsleaveoptionforfamilywithnewborn,MaternalNursingconcernsareas,PrenatalcareLowbirthweightMotherandinfantwithHIVinfectionAdolescentpregnancyDrugandsubstanceabuseduringpregnancySocial/familystressandimpactstopregnantwomenandfamilyUseandcareforpregnantwomen,SpecialIssuesinWomensHealth,ViolenceSexualTransmittedDiseases:HIV/AIDS86%ofpediatricAIDScasesaretransmittedthroughverticaltransmissionofHIVSubstanceabuseOtherdiseases:Heartdiseases,cancer,osteoporosis,eatingdisorders,TheMenstrualCycle,OvarianCycle:1.Follicularphase:stimulatedwithFSHtopromotethedevelopmentoffolliclesEstrogen-folliclemature-negativefeedbacktohypothalamusandanteriorpituitaryglandinhibitingFSHsecretion2.Ovulation:increaseinbodytemperature(progesteronesecretion),fernpatternofthecervicalmucus,spinnbarkeit“elasticityoftheovulatory”duetosecretionoftheestrogen,TheMenstrualCycle,3.LutealPhase:Corpusluteumandanteriorpituitaryglandwillsecretluteinizinghormones(thedecreaseinEstrogenandprogesteronepositivefeedbacktoHypothalamusandanteriorpituitary-stimulatingthesecretionofFSH4.Premenstrualphase:Declineinestrogenandprogesterone,TheMenstrualCycle,EndometrialCycle:ProliferativephaseSecretaryphaseMenstrualphase,Question,FSHstimulateswhichprocessesinthemenstrualCycle?ThinkingofendometriumMaturationoffollicleDecreaseinbasalbodytemperatureIncreaseinprogesteroneproduction,InfertilityCare,Infertilityaffects15-20%ofthepopulationsinthereproductiveyearsTermstobeunderstood:ArtificialinseminationEndometriosisLaparoscopyPrimaryInfertilitySecondaryInfertilityVaricoceleEndometriosis,TermsrelatedtoInfertilityTreatment,InvitroFertilization/embryoTransferGameteintrafallopiantubetransfer(GIFT)ZygoteIntrafallopianTransfer(ZIFT)Testingofinfertility:OvulatoryAnalysisSpermAnalysisTestingofSTDSTubalPatencytest,Question,Inwhichphaseofthemenstrualcycleisthick,scantcervicalmucusandanelevatedBBTseen?EstrogenicphaseMenstrualPhaseOvulatoryphaseLutealPhase,Namesoftheinfertilitydrugs,Clomiphene“Clomid”-riskofmultipleovulationhCG:tofacilitatetheovulation,sideeffectovarianover-stimulationhMG+Menotropin:HumanMenopausalgonadotropinDanazol:suppressesovulationandsecretionofFSHandLuteinizinghormonetoinactiveectopicendometrialtissue.Sideeffect-Wtgain,hotflashes,decreasedbreastsize,vaginitis,Nursingcareforinfertilecouple,Identifyproblemsandstrengths:Self-esteemdisturbancerelatedtodiagnosisPersonalIdentitydisturbance,relatedtounsuccessfulinfertilitytreatmentIneffectivefamilycoping,compromisedliveanddecisionmakingNurse=supporter,advocate,counseling,PregnancyTermination,Legal/ethicalDecisionmakingdilemmasCounselingregardingpregnancyterminationPsychologicalimpactofpregnancyterminationRiskandcomplicationassociatedGrief/guilt/ambivalence/uncertaintyfeelingafterterminatingofpregnancy,SexuallyTransmittedDiseases,ChamydiatrachmatisinfectionGonorrheaHumanPapillomavirusHerpesSimplexVirustype2infectionCytomegalovirusinfectionSyphilisVaginitisHumanImmunodeficiencyVirusInfection,Quesiton,WomenshouldbetaughttobeawareofearlywarningsignsofHIVinfectionwhichare:DyspareuniaSeveredysmenorrheaOccasionalCandidainfectionRecurrentepisodesofgenitalwarts,Question,ThepurposeoftakingTamoxifenafteramastectomyisto:AlleviatecancerpainActashormonalreplacementtherapyBlocktissueuptakeandutilizationofestrogenDestroyanystraycancercellsinremainingbreasttissue,FamilySystemChangesDuringTheChildbearingCycle,StructurePowerBoundariesAffectorfeelingsIntergenerationalpatternsandrolesCommunicationpatternsCulturalbackgroundandriturals,BondingandAttachement,BondingisaffectedbyMaternal-Sensitiveperiod.Attachmentisdevelopedthroughoutthefirstyearoflife.Importantfornursingpractice:donotmakeinaccuratejudgment,understandthatchildbearingisamajortransitionIthelifeofafamily,NursinginterventionforthethreePhasesofcrisis,Precrisis:PredictableanddevelopmenteventsinthelifecycleDiscusschangewithfamilystructure,addingnewmemberAssessriskfactors,pastcopingandproblemsolvingImplementhealthteachingImplementhealthpromotionandmaintenancestrategies,NursinginterventionforthethreePhasesofcrisis,Crisis:CopingstrategiesnotsufficienttodealwithchangesinfamilystructureandproblemindevelopmentClarifytheproblemAssistthefamilyingoinganunderstandingofthesituationAcceptanceofthefamilyUseappropriateinterpersonalandinstitutionalresourcesAssessfamilytoexpressfeeling&waysofsolvingproblem,NursinginterventionforthethreePhasesofcrisis,Postcrisis:Crisishasbeenresolved,leadingtoahigher,thesame,orloweroffamilyfunctionSupportthefamilyinitsnewstrategiesofresolutionEmphasizegrowthpotentialinsolutionsAttempttoreverseorlesseneffectsofmaladaptationthroughappropriaterehabilitativeeffortortherapy,PsychosocialaspectsofchildbearingTheories,1.PsychosocialChangeinthemother:AcceptingthepregnancySymbolicmeaningofthepregnancySelf-imageandbodyimageduringpregnancy,PsychosocialaspectsofchildbearingTheories,2.RoleAssumptionandmaternalAdaptationMaternalIdentityMaternalroleattainment:Motivationformotherhood,preparationformotherhood,conflictresolution,maternalattachmentbehavior,relationshipwithmotherRoleconflictandattainmentofthematernalrole,Roleconflictandattainmentofthematernalrole,Inabilitytoachievethe“goodMother”roleLackofknowledgeandpreparationforthematernalroleEstablishingarelationshipwiththefetus,MaternalAmbivalenceinPregnancy,Noquestionsaskedaboutpregnancy,laboranddelivery,infantcareNointerestinfetusPastnegativeexperiencewithpregnancyorlaboranddeliveryDenialofpregnancyandfetalmovementPregnancyandparenthoodinterferingwithlifestyleContinueactivitiesthatmayhurtthefetus(smokingordrinking)Reportingpersistentandmanyphysicalcomplains.,RhImmunization,CheckbyIndirectCoombstesttodetectantibodiesintheserumthattargetredbloodantigenstocausefetushemolysisAntibodytiter1:16indicatespossibilityofseverehemolyticdiseasesMotherwithRh-negative:shouldreceiveRhogamwithin72hours(anyinvasiveprocedurethatmaycausethemixingofthematernalbloodwithfetus),PsychosocialaspectsofchildbearingTheories,3.PsychosocialChangeinthefather:DevelopmentofthefatherroleParticipationinthechildbearingcycleFather-infantinteractionsandthefatherrole“TheCouvadeSyndrome”-bodilysymptomsexperiencedbyafatherduringthecourseofhispartnerspregnancy.4.PsychosocialChangeinSiblingview,AdaptationtoPregnancy,Keyterms:AcquaintanceAmbivalenceAttachmentAvoidanceBonding,Mrs.H.33wkssharedthatherhusbandwasafraidofharmingtheunbornbabyduringintercourse.Whichisthebestresponseofthenurse?“Gentlevaginalintercourseissafethroughoutpregnancy”“eachcouplehasauniquesituation,bringyourhusbandinforatalkwiththedoctor”“Thebabyiswellprotectedbyyourtissues,butifcontractionsoccur,abstainandnotifythedoctor”“vaginalPenetrationisprohibitedanywayduringthelastmonthofpregnancybecauseofthedangersofinfection”3,Whenteachingprospectivefathersaboutpregnancyandbirth,thenurseshouldplantoincludewhichpriorityinformation?ThepossibledifficultiesineachtrimesterThecostofcaringandraisingachildThenormalrangeoffeelingthatmayexperiencedindifferentstagesofpregnancyTheimportanceofhisroleintheactofconceptionandinthedeterminationofthesexofthefetus.3,Pregnancyandweightgain,FirstTrimester:2-4pounds(0.9-1.8kg),1poundperweek(0.45kg)during1st&2ndtrimesterTotalweightgain13.18kgor29pounds,PregnancyandNutrition,Obesity:recommendtogainwt7-11.5kgUnderweightTeenagepregnancy:lowwtgainduringpregnancy,associatedwithLBWinfant19%ofthebabywt2000gramdecrease7.4%ofLWBinfantifwtgainimproveto11kg(25lbs).Frequentmealskippingandconsumptionoffastfood(highsalt,sugar,lowvitandminerals),RiskofObesitytopregnancy,GestationaldiabetesUrinarytractinfectionsInadequateweightgainWoundinfectionThromboembolismPIHFetalmonitoringdifficultyProlongedlaborFetalMacrosomiaBirthtrauma,Question-Nutrition,Incomparisonwithasinglefetuspregnancy,nutritionneedswhentherearetwinsmuchinclude:Increasedcalorieintakeof300perfetuseachdayLow-saltfoodstopreventedemaAdditionalfluidintakeof2-3glassesperdayIronandfolicacidneedsfor10%moreperday,WarningSignsinPregnancy,HeadacheAlteredvision:blurring,doublevision,seeingspotsNausea/vomitingEpigastricpain/abdominalpainMuscularirritability/seizuresSignsofinfection:fever,burninginurination,flankpain,diarrhea,VaginalbleedingDecreaseorcessationoffetalmovement,AssessmentforNeuralTubeDefects,“open”neuraltubedefectsleakalpha-fetoprotein(AFP)ElevateAFPlevelinmaternalserumandamnioticfluidmayindicatethefetushasneuraltubedefects,Amniocentesis,Performedaround15-18weeksofgestationtoidentifygeneticabnormalityRisk:Traumatothefetus,placenta,umbilicalcord,ormaternalstructuresInfectionPrematurelaborandspontaneousabortion,Amniocentesis,Warningsignsafterreceivingamniocentesis:BodytemperatureelevationFluidleakingfromthevaginalMildCrampingandabdominalachingDecreasedfetalmovement,ChorionicVillusSampling,TodetectgeneticorchromosomaldefectsCanbedoneinearlypregnancy9-10weeksgestationRisk:miscarriage3.7-7.7%,1.7%discrepancyofresultbetweenvilluskaryotypeandfetus,ruptureamnioticsac,chorioamnionitis,oligohydramnios,intrauterinegrowthretardation,TheNonstresstest,Checkfetuswell-beingCheckfetalmovementinrelationtofetalheartrateaccelerationReactive:HRaccelerationwithfetusmovementNonreactive:noHRaccelerationwithfetusmovement,GeneticProblem,AutosomalRecessiveDisorders:25%oftheRiskofpassingthedisordertoeachoftheiroffspring.1:4chanceofdemonstratingthedisorder,50%changeofbeingacarriertotherecessivetrait,eachchildhas25%chancesofnothavingthediseasesandnotbeingacarrier-Cysticfibrosis,PKU,Sicklecellanemia,-X-linkeddisorders:Hemophilia,colorblindness,G6PD,NursingandfamilywithGeneticdisorders,PerformKaryotypeexaminationGeneticCounseling-supportfordecisionmakingGeneticscreenforpotentialrisk,AssistingtheclienttocopewithFirst-TrimesterDiscomforts,Nausea/vomiting-morningsicknessPtyalism“excesssalivainthemouth”AlteredtasteBleedinggumsBreasttendernessUrinaryfrequencyNasalstuffinessandEpistaxisIncreasedvaginalsecretionFatigue,EnsureSafetyandremovingbarrierstocare,Promotingclientsafety:home,work,lifestyle,environment,danger/warningsignsofpregnancyRemovingbarriers:SocialEconomicfactors,lackofinsurance,inabilitytopay,lackoffreeprenatalservice,limitaccesstoprenatalcareforeconomicallypoorwomen,limitedorexpensivetransportation,smallchildren,cultural,Psychologicchangesandconcernsofamotherat2ndTrimester,AwareofthatthepregnancycanberecognizedbyothersAcceptanceofpregnancyMaternalroleattainment:fetusmovementfostersinternalizationandfantasyFantasies:bindingtoinfantsRelationshipwithmotherBodyimage:beginstoviewfetusasseparateformownbody,changetheperceptionofbodyboundaryasprotectivebarriertofetus,Question,Thenurseshouldassessforwhichdevelopmentaltaskofthepregnantwomeninherthirdtrimester?BondingtothefetusinpreparationforbirthAcceptingthefetusasawantedresponsibilityUnderstandingthebabyisanindependentbeingPreparingtoseparatefromthefetusthroughthebirthprocess,Question-DMmother,Thenurseteachesthenewlypregnantdiabetictheimportanceofselfglucosemonitoringinthefirsttrimestertoprevent:HypoxiainthefetusTheonsetofdiabetesinfetusUnusuallylargefetaldevelopmentTeratogeniceffectsofhyperglycemia,Question-PretermLabor,MagnesiumSulfatemaybeprescribedasatocolyticdrugbecauseoneoftheexpectedactionsis:PromotingdiuresisLoweringbloodpressureInducingsedationandrestPromotingsmoothmusclerelaxation,Painduringlabor,Analgesia:demerol(meperidine)Sedative:SeconalandNembutalNarcoticanalgesics:Fentanyl,StabolAnesthesia:Marcaine(Bupavacaine)Alfenta(Alfentani),EpiduralBlock,Givetowomenin2-4cmCxdilationGivinganesthesiologistintoepidualspaceatL-2,L-3,L-4orL-5ProvidepainreliefinlowerpartofbodyLaborstimulationbyOxytocinmayneedPreventHypotensiveeffect(500-1000mlLactatedRingers)Monitoringuteruscontractionandfetuscondition,SideEffectsofEpiduralAnalgesia,Respiratorydepressioninnewborn(Narcan)Pruitus(itching)NauseaandvomitingUrinaryretentionHypotensiveAffectlaborprocess,unabletopushduringsecondstageoflabor(assessmentimportant),Question,AClienthasreceivedaneffectivedoseofepiduralanesthesia.TheIVrateis250ml/hourandpositionissemi-Fowlers.Herbloodpressurehasdroppedsignificantly.Thefirstnursinginterventionisto:SlowtherateofIVinfusiontoavoidoverloadRetaketheBP,initialhypotensionisexpectedBeginoxygenbyfacemask,lowerhead,elevatelegs.Callbackanesthesiologisttodealwiththecondition,InductionorAugmentationofLabor,Induction:startinglaborartificiallybyoxytocinAugmentation:stimulationoflaboronceithasbegunnaturally.Amniotomy:coloroftheamnioticfluidAssessrisk:frequencyofcontraction,maternaltolerance,pain,fetuswell-being,discomfort,progressoflabor,complication,LamazeTechniqueQuestion,ThenurseteachingtheLamazetechniqueevaluateshersuccesswhenthecoupledothefollowing:Breakthefear/tension/paincycleBondsuccessfullywiththenewbornUsepositivefeedbackwitheachotherduringlaborMaintaincontrolduringlaborbytheirtechniquesofbreathingandrelaxation,Question(painandchildbirthclass),Indevelopingchildbirthclassesthenurseplanstoincludetechniquesthatnormallyminimizepainperception,whichoftheseareinappropriate?UsingmusclerelaxationmethodsInvalidatingtheperceptionofpainRefocusingattentiononanothersubjectImplementinganxietyreductiontechniques,Indevelopingchildbirthclassesthenurseplanstincludetechniquesthatnormallyminimizepainperception,whichoftheseareinappropriate?UsingmusclerelaxationmethodsInvalidatingthepainperceptionRefocusingattentiononanothersubjectImplementinganxietyreductiontechniques,VaginalBirthAfterCesareanSection(VBAC),RepeatCSinUSA80%FearofweakeningtheuterinescareTwiceMaternalRiskinC/SthaninVaginalbirthQualification:primarycesareannotduetopelvicfactors.“Classicuterineincision?”SupportofstaffandwomensdesiretohavevaginalbirthareoptimalfactorfortryingVBAC,Question,