回顾母婴护理-母婴护理-护理学-25.

1、徐丽华 上海交通大学护理学院 2006427 lDevelopment standard of care, certification, advanced practice nurses lHome Health care for postpartum women, discharge from Hops. 12-24 hours after delivery, high risk infants discharge home earlier than before lConsumer involved in the childbearing care: Child birth class,

2、sibling present, breast-feeding, birthing environment (LDR, LDRP), fathers involvement, parents leave option for family with newborn lPrenatal care lLow birth weight lMother and infant with HIV infection lAdolescent pregnancy lDrug and substance abuse during pregnancy lSocial/family stress and impac

3、ts to pregnant women and family lUse and care for pregnant women lViolence lSexual Transmitted Diseases: HIV/AIDS 86% of pediatric AIDS cases are transmitted through vertical transmission of HIV lSubstance abuse lOther diseases: Heart diseases, cancer, osteoporosis, eating disorders Ovarian Cycle: 1

4、. Follicular phase: stimulated with FSH to promote the development of follicles Estrogen-follicle mature-negative feedback to hypothalamus and anterior pituitary gland inhibiting FSH secretion 2. Ovulation: increase in body temperature (progesterone secretion), fern pattern of the cervical mucus, sp

5、innbarkeit “elasticity of the ovulatory”due to secretion of the estrogen 3.Luteal Phase: Corpus luteum and anterior pituitary gland will secret luteinizing hormones (the decrease in Estrogen and progesterone positive feedback to Hypothalamus and anterior pituitary- stimulating the secretion of FSH 4

6、. Premenstrual phase: Decline in estrogen and progesterone Endometrial Cycle: Proliferative phase Secretary phase Menstrual phase FSH stimulates which processes in the menstrual Cycle? lThinking of endometrium lMaturation of follicle lDecrease in basal body temperature a.Increase in progesterone pro

7、duction lInfertility affects 15-20% of the populations in the reproductive years Terms to be understood: Artificial insemination Endometriosis Laparoscopy Primary Infertility Secondary Infertility Varicocele Endometriosis lIn vitro Fertilization/embryo Transfer lGamete intrafallopian tube transfer (

8、GIFT) lZygote Intrafallopian Transfer (ZIFT) lTesting of infertility: Ovulatory Analysis Sperm Analysis Testing of STDS Tubal Patency test In which phase of the menstrual cycle is thick, scant cervical mucus and an elevated BBT seen? Estrogenic phase Menstrual Phase Ovulatory phase 1.Luteal Phase lC

9、lomiphene “Clomid”-risk of multiple ovulation lhCG: to facilitate the ovulation , side effect ovarian over-stimulation lhMG + Menotropin: Human Menopausal gonadotropin lDanazol: suppresses ovulation and secretion of FSH and Luteinizing hormone to inactive ectopic endometrial tissue. Side effect-Wt g

10、ain, hot flashes, decreased breast size, vaginitis lIdentify problems and strengths: Self-esteem disturbance related to diagnosis Personal Identity disturbance, related to unsuccessful infertility treatment Ineffective family coping, compromised live and decision making Nurse =supporter, advocate, c

11、ounseling, lLegal/ethical Decision making dilemmas lCounseling regarding pregnancy termination lPsychological impact of pregnancy termination lRisk and complication associated lGrief/guilt/ambivalence/uncertainty feeling after terminating of pregnancy lChamydia trachmatis infection lGonorrhea lHuman

12、 Papillomavirus lHerpes Simplex Virus type 2 infection lCytomegalovirus infection lSyphilis lVaginitis lHuman Immunodeficiency Virus Infection Women should be taught to be aware of early warning signs of HIV infection which are: lDyspareunia lSevere dysmenorrhea lOccasional Candida infection a.Recur

13、rent episodes of genital warts The purpose of taking Tamoxifen after a mastectomy is to: lAlleviate cancer pain lAct as hormonal replacement therapy lBlock tissue uptake and utilization of estrogen lDestroy any stray cancer cells in remaining breast tissue lStructure lPower lBoundaries lAffect or fe

14、elings lIntergenerational patterns and roles lCommunication patterns lCultural background and riturals lBonding is affected by Maternal-Sensitive period. lAttachment is developed through out the first year of life. lImportant for nursing practice: do not make inaccurate judgment, understand that chi

15、ldbearing is a major transition I the life of a family Precrisis: Predictable and development events in the life cycle Discuss change with family structure, adding new member Assess risk factors, past coping and problem solving Implement health teaching 1.Implement health promotion and maintenance s

16、trategies Crisis: Coping strategies not sufficient to deal with changes in family structure and problem in development Clarify the problem Assist the family in going an understanding of the situation Acceptance of the family Use appropriate interpersonal and institutional resources 1.Assess family t

17、o express feeling & ways of solving problem Postcrisis: Crisis has been resolved, leading to a higher, the same, or lower of family function Support the family in its new strategies of resolution Emphasize growth potential in solutions 1.Attempt to reverse or lessen effects of maladaptation through

18、appropriate rehabilitative effort or therapy 1. Psychosocial Change in the mother: Accepting the pregnancy Symbolic meaning of the pregnancy Self-image and body image during pregnancy 2. Role Assumption and maternal Adaptation lMaternal Identity lMaternal role attainment: Motivation for motherhood,

19、preparation for motherhood, conflict resolution, maternal attachment behavior, relationship with mother lRole conflict and attainment of the maternal role lInability to achieve the “good Mother”role lLack of knowledge and preparation for the maternal role lEstablishing a relationship with the fetus

20、lNo questions asked about pregnancy, labor and delivery, infant care lNo interest in fetus lPast negative experience with pregnancy or labor and delivery lDenial of pregnancy and fetal movement lPregnancy and parenthood interfering with life style lContinue activities that may hurt the fetus (smokin

21、g or drinking) lReporting persistent and many physical complains. lCheck by Indirect Coombs test to detect antibodies in the serum that target red blood antigens to cause fetus hemolysis lAntibody titer 1:16 indicates possibility of severe hemolytic diseases lMother with Rh-negative: should receive

22、Rhogam within 72 hours (any invasive procedure that may cause the mixing of the maternal blood with fetus) 3. Psychosocial Change in the father: Development of the father role Participation in the childbearing cycle Father-infant interactions and the father role “The Couvade Syndrome”-bodily symptom

23、s experienced by a father during the course of his partners pregnancy. 4. Psychosocial Change in Sibling view lKey terms: Acquaintance Ambivalence Attachment Avoidance Bonding Mrs. H. 33 wks shared that her husband was afraid of harming the unborn baby during intercourse. Which is the best response

24、of the nurse? “Gentle vaginal intercourse is safe throughout pregnancy” “each couple has a unique situation, bring your husband in for a talk with the doctor” “The baby is well protected by your tissues, but if contractions occur, abstain and notify the doctor” “vaginal Penetration is prohibited any

25、way during the last month of pregnancy because of the dangers of infection” 3 When teaching prospective fathers about pregnancy and birth, the nurse should plan to include which priority information? The possible difficulties in each trimester The cost of caring and raising a child The normal range

26、of feeling that may experienced in different stages of pregnancy The importance of his role in the act of conception and in the determination of the sex of the fetus. 3 lFirst Trimester: 2-4 pounds (0.9-1.8 kg), 1 pound per week (0.45 kg) during 1st & 2nd trimester lTotal weight gain 13.18 kg or 29

27、pounds lObesity: recommend to gain wt 7-11.5 kg lUnderweight lTeenage pregnancy: low wt gain during pregnancy, associated with LBW infant 19% of the baby wt 2000 gram decrease 7.4% of LWB infant if wt gain improve to 11kg (25 lbs). Frequent meal skipping and consumption of fast food (high salt, suga

28、r, low vit and minerals) lGestational diabetes lUrinary tract infections lInadequate weight gain lWound infection lThromboembolism lPIH lFetal monitoring difficulty lProlonged labor lFetal Macrosomia lBirth trauma In comparison with a single fetus pregnancy, nutrition needs when there are twins much

29、 include: lIncreased calorie intake of 300 per fetus each day lLow-salt foods to prevent edema lAdditional fluid intake of 2-3 glasses per day a.Iron and folic acid needs for 10% more per day lHeadache lAltered vision: blurring, double vision, seeing spots lNausea/vomiting lEpigastric pain/abdominal

30、 pain lMuscular irritability/seizures lSigns of infection:fever, burning in urination, flank pain, diarrhea, lVaginal bleeding lDecrease or cessation of fetal movement l“open” neural tube defects leak alpha- fetoprotein (AFP) lElevate AFP level in maternal serum and amniotic fluid may indicate the f

31、etus has neural tube defects lPerformed around 15-18 weeks of gestation to identify genetic abnormality lRisk: Trauma to the fetus, placenta, umbilical cord, or maternal structures Infection Premature labor and spontaneous abortion Warning signs after receiving amniocentesis: Body temperature elevat

32、ion Fluid leaking from the vaginal Mild Cramping and abdominal aching 1.Decreased fetal movement lTo detect genetic or chromosomal defects lCan be done in early pregnancy 9-10 weeks gestation lRisk: miscarriage 3.7-7.7%, 1.7% discrepancy of result between villus karyotype and fetus, rupture amniotic

33、 sac, chorioamnionitis, oligohydramnios, intrauterine growth retardation lCheck fetus well-being lCheck fetal movement in relation to fetal heart rate acceleration lReactive: HR acceleration with fetus movement lNon reactive: no HR acceleration with fetus movement lAutosomal Recessive Disorders: 25%

34、 of the Risk of passing the disorder to each of their offspring. 1:4 chance of demonstrating the disorder, 50% change of being a carrier to the recessive trait, each child has 25% chances of not having the diseases and not being a carrier -Cystic fibrosis, PKU, Sickle cell anemia, -X-linked disorder

35、s: Hemophilia, color blindness, G6PD lPerform Karyotype examination lGenetic Counseling-support for decision making lGenetic screen for potential risk lNausea/vomiting-morning sickness lPtyalism “excess saliva in the mouth” lAltered taste lBleeding gums lBreast tenderness lUrinary frequency lNasal s

36、tuffiness and Epistaxis lIncreased vaginal secretion lFatigue lPromoting client safety: home, work, lifestyle, environment, danger/warning signs of pregnancy lRemoving barriers: Social Economic factors, lack of insurance, inability to pay, lack of free prenatal service, limit access to prenatal care

37、 for economically poor women, limited or expensive transportation, small children, cultural lAware of that the pregnancy can be recognized by others lAcceptance of pregnancy lMaternal role attainment: fetus movement fosters internalization and fantasy lFantasies: binding to infants lRelationship wit

38、h mother lBody image: begins to view fetus as separate form own body, change the perception of body boundary as protective barrier to fetus The nurse should assess for which developmental task of the pregnant women in her third trimester? lBonding to the fetus in preparation for birth lAccepting the

39、 fetus as a wanted responsibility lUnderstanding the baby is an independent being a.Preparing to separate from the fetus through the birth process The nurse teaches the newly pregnant diabetic the importance of self glucose monitoring in the first trimester to prevent: lHypoxia in the fetus lThe ons

40、et of diabetes in fetus lUnusually large fetal development a.Teratogenic effects of hyperglycemia Magnesium Sulfate may be prescribed as a tocolytic drug because one of the expected actions is: lPromoting diuresis lLowering blood pressure lInducing sedation and rest a.Promoting smooth muscle relaxat

41、ion lAnalgesia: demerol (meperidine) lSedative: Seconal and Nembutal lNarcotic analgesics: Fentanyl, Stabol lAnesthesia: Marcaine (Bupavacaine) Alfenta (Alfentani) lGive to women in 2-4 cm Cx dilation lGiving anesthesiologist into epidual space at L-2, L-3, L-4 or L-5 lProvide pain relief in lower p

42、art of body lLabor stimulation by Oxytocin may need lPrevent Hypotensive effect (500-1000 ml Lactated Ringers) lMonitoring uterus contraction and fetus condition lRespiratory depression in newborn (Narcan) lPruitus (itching) lNausea and vomiting lUrinary retention lHypotensive lAffect labor process,

43、 unable to push during second stage of labor (assessment important) A Client has received an effective dose of epidural anesthesia. The IV rate is 250 ml/hour and position is semi-Fowlers. Her blood pressure has dropped significantly. The first nursing intervention is to: lSlow the rate of IV infusi

44、on to avoid overload lRetake the BP, initial hypotension is expected lBegin oxygen by face mask, lower head, elevate legs. a.Call back anesthesiologist to deal with the condition lInduction: starting labor artificially by oxytocin lAugmentation: stimulation of labor once it has begun naturally. lAmn

45、iotomy: color of the amniotic fluid lAssess risk: frequency of contraction, maternal tolerance, pain, fetus well-being, discomfort, progress of labor, complication The nurse teaching the Lamaze technique evaluates her success when the couple do the following: lBreak the fear/tension/pain cycle lBond

46、 successfully with the newborn lUse positive feedback with each other during labor a.Maintain control during labor by their techniques of breathing and relaxation In developing childbirth classes the nurse plans to include techniques that normally minimize pain perception, which of these are inappro

47、priate? lUsing muscle relaxation methods lInvalidating the perception of pain lRefocusing attention on another subject a.Implementing anxiety reduction techniques In developing childbirth classes the nurse plans t include techniques that normally minimize pain perception, which of these are inapprop

48、riate? Using muscle relaxation methods Invalidating the pain perception Refocusing attention on another subject Implementing anxiety reduction techniques lRepeat CS in USA 80% lFear of weakening the uterine scare lTwice Maternal Risk in C/S than in Vaginal birth lQualification: primary cesarean not due to pelvic factors. “Classic uterine incision?” lSupport of staff and womens desire to have vaginal birth are optimal factor for trying VBAC When membranes rupture spont