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Review of Maternal-Infant Nursing

2006427

Trends in Maternal-Infant Nursing Care

Development standard of care, certification, advanced practice nurses Home Health care for postpartum women, discharge from Hops. 12-24 hours after delivery, high risk infants discharge home earlier than before Consumer involved in the childbearing care: Child birth class, sibling present, breast-feeding, birthing environment (LDR, LDRP), fathers involvement, parents leave option for family with newborn

Maternal Nursing concerns areas

Prenatal care Low birth weight Mother and infant with HIV infection Adolescent pregnancy Drug and substance abuse during pregnancy Social/family stress and impacts to pregnant women and family Use and care for pregnant women

Special Issues in Womens Health

Violence Sexual Transmitted Diseases: HIV/AIDS 86% of pediatric AIDS cases are transmitted through vertical transmission of HIV Substance abuse Other diseases: Heart diseases, cancer, osteoporosis, eating disorders

The Menstrual Cycle


Ovarian Cycle: 1. 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, spinnbarkeit elasticity of the ovulatorydue to secretion of the estrogen

The Menstrual Cycle


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 pituitarystimulating the secretion of FSH 4. Premenstrual phase: Decline in estrogen and progesterone

The Menstrual Cycle


Endometrial Cycle: 1. Proliferative phase 2. Secretary phase 3. Menstrual phase

Question
FSH stimulates which processes in the menstrual Cycle? a. Thinking of endometrium b. Maturation of follicle c. Decrease in basal body temperature d. Increase in progesterone production

Infertility Care

1.

2.
3. 4.

5.
6. 7.

Infertility affects 15-20% of the populations in the reproductive years Terms to be understood: Artificial insemination Endometriosis Laparoscopy Primary Infertility Secondary Infertility Varicocele Endometriosis

Terms related to Infertility Treatment

In vitro Fertilization/embryo Transfer Gamete intrafallopian tube transfer (GIFT) Zygote Intrafallopian Transfer (ZIFT) Testing of infertility:
1. 2. 3. 4.

Ovulatory Analysis Sperm Analysis Testing of STDS Tubal Patency test

Question
In which phase of the menstrual cycle is thick, scant cervical mucus and an elevated BBT seen?
1. Estrogenic phase
2. Menstrual Phase 3. Ovulatory phase

4. Luteal Phase

Names of the infertility drugs


Clomiphene Clomid-risk of multiple ovulation hCG: to facilitate the ovulation , side effect ovarian over-stimulation hMG + Menotropin: Human Menopausal gonadotropin Danazol: suppresses ovulation and secretion of FSH and Luteinizing hormone to inactive ectopic endometrial tissue. Side effect-Wt gain, hot flashes, decreased breast size, vaginitis

Nursing care for infertile couple

Identify 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, counseling,

Pregnancy Termination

Legal/ethical Decision making dilemmas Counseling regarding pregnancy termination Psychological impact of pregnancy termination Risk and complication associated Grief/guilt/ambivalence/uncertainty feeling after terminating of pregnancy

Sexually Transmitted Diseases

Chamydia trachmatis infection Gonorrhea Human Papillomavirus Herpes Simplex Virus type 2 infection Cytomegalovirus infection Syphilis Vaginitis Human Immunodeficiency Virus Infection

Quesiton
Women should be taught to be aware of early warning signs of HIV infection which are: a. Dyspareunia b. Severe dysmenorrhea c. Occasional Candida infection d. Recurrent episodes of genital warts

Question
The purpose of taking Tamoxifen after a mastectomy is to: a. Alleviate cancer pain b. Act as hormonal replacement therapy c. Block tissue uptake and utilization of estrogen d. Destroy any stray cancer cells in remaining breast tissue

Family System Changes During The Childbearing Cycle

Structure Power Boundaries Affect or feelings Intergenerational patterns and roles Communication patterns Cultural background and riturals

Bonding and Attachement

Bonding is affected by Maternal-Sensitive period. Attachment is developed through out the first year of life. Important for nursing practice: do not make inaccurate judgment, understand that childbearing is a major transition I the life of a family

Nursing intervention for the three Phases of crisis


Precrisis: Predictable and development events in the life cycle 1. Discuss change with family structure, adding new member 2. Assess risk factors, past coping and problem solving 3. Implement health teaching 4. Implement health promotion and maintenance strategies

Nursing intervention for the three Phases of crisis


Crisis: Coping strategies not sufficient to deal with changes in family structure and problem in development 1. Clarify the problem 2. Assist the family in going an understanding of the situation 3. Acceptance of the family 4. Use appropriate interpersonal and institutional resources 5. Assess family to express feeling & ways of solving problem

Nursing intervention for the three Phases of crisis


Postcrisis: Crisis has been resolved, leading to a higher, the same, or lower of family function 1. Support the family in its new strategies of resolution 2. Emphasize growth potential in solutions 3. Attempt to reverse or lessen effects of maladaptation through appropriate rehabilitative effort or therapy

Psychosocial aspects of childbearing Theories


1. Psychosocial Change in the mother: Accepting the pregnancy
Symbolic meaning of the pregnancy

Self-image and body image during

pregnancy

Psychosocial aspects of childbearing Theories


2. Role Assumption and maternal Adaptation Maternal Identity Maternal role attainment: Motivation for motherhood, preparation for motherhood, conflict resolution, maternal attachment behavior, relationship with mother Role conflict and attainment of the maternal role

Role conflict and attainment of the maternal role


Inability to achieve the good Motherrole Lack of knowledge and preparation for the maternal role Establishing a relationship with the fetus

Maternal Ambivalence in Pregnancy


No questions asked about pregnancy, labor and delivery, infant care No interest in fetus Past negative experience with pregnancy or labor and delivery Denial of pregnancy and fetal movement Pregnancy and parenthood interfering with life style Continue activities that may hurt the fetus (smoking or drinking) Reporting persistent and many physical complains.

Rh Immunization

Check by Indirect Coombs test to detect antibodies in the serum that target red blood antigens to cause fetus hemolysis Antibody titer > 1:16 indicates possibility of severe hemolytic diseases Mother with Rh-negative: should receive Rhogam within 72 hours (any invasive procedure that may cause the mixing of the maternal blood with fetus)

Psychosocial aspects of childbearing Theories


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 symptoms experienced by a father during the course of his partners pregnancy. 4. Psychosocial Change in Sibling view

Adaptation to Pregnancy

Key terms:
1. Acquaintance 2. Ambivalence

3. Attachment
4. Avoidance 5. Bonding

Mrs. H. 33 wks shared that her husband was afraid of harming the unborn baby during intercourse. Which is the best response of the nurse? A. Gentle vaginal intercourse is safe throughout pregnancy B. each couple has a unique situation, bring your husband in for a talk with the doctor C. The baby is well protected by your tissues, but if contractions occur, abstain and notify the doctor D. vaginal Penetration is prohibited anyway 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? A. The possible difficulties in each trimester B. The cost of caring and raising a child C. The normal range of feeling that may experienced in different stages of pregnancy D. The importance of his role in the act of conception and in the determination of the sex of the fetus. 3

Pregnancy and weight gain

First Trimester: 2-4 pounds (0.9-1.8 kg), 1 pound per week (0.45 kg) during 1st & 2nd trimester Total weight gain 13.18 kg or 29 pounds

Pregnancy and Nutrition

Obesity: recommend to gain wt 7-11.5 kg Underweight Teenage 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, sugar, low vit and minerals)

Risk of Obesity to pregnancy

Gestational diabetes Urinary tract infections Inadequate weight gain Wound infection Thromboembolism PIH Fetal monitoring difficulty Prolonged labor Fetal Macrosomia Birth trauma

Question-Nutrition
In comparison with a single fetus pregnancy, nutrition needs when there are twins much include: a. Increased calorie intake of 300 per fetus each day b. Low-salt foods to prevent edema c. Additional fluid intake of 2-3 glasses per day d. Iron and folic acid needs for 10% more per day

Warning Signs in Pregnancy


Headache Altered vision: blurring, double vision, seeing spots Nausea/vomiting Epigastric pain/abdominal pain Muscular irritability/seizures Signs of infection:fever, burning in urination, flank pain, diarrhea, Vaginal bleeding Decrease or cessation of fetal movement

Assessment for Neural Tube Defects


open neural tube defects leak alphafetoprotein (AFP) Elevate AFP level in maternal serum and amniotic fluid may indicate the fetus has neural tube defects

Amniocentesis

Performed around 15-18 weeks of gestation to identify genetic abnormality Risk:


1. Trauma to the fetus, placenta, umbilical cord,

or maternal structures 2. Infection 3. Premature labor and spontaneous abortion

Amniocentesis
Warning signs after receiving amniocentesis: 1. Body temperature elevation 2. Fluid leaking from the vaginal 3. Mild Cramping and abdominal aching 4. Decreased fetal movement

Chorionic Villus Sampling

To detect genetic or chromosomal defects Can be done in early pregnancy 9-10 weeks gestation Risk: miscarriage 3.7-7.7%, 1.7% discrepancy of result between villus karyotype and fetus, rupture amniotic sac, chorioamnionitis, oligohydramnios, intrauterine growth retardation

The Nonstress test

Check fetus well-being Check fetal movement in relation to fetal heart rate acceleration Reactive: HR acceleration with fetus movement Non reactive: no HR acceleration with fetus movement

Genetic Problem

Autosomal Recessive Disorders: 25% 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 disorders: Hemophilia, color blindness, G6PD

Nursing and family with Genetic disorders

Perform Karyotype examination Genetic Counseling-support for decision making Genetic screen for potential risk

Assisting the client to cope with First-Trimester Discomforts

Nausea/vomiting-morning sickness Ptyalism excess saliva in the mouth Altered taste Bleeding gums Breast tenderness Urinary frequency Nasal stuffiness and Epistaxis Increased vaginal secretion Fatigue

Ensure Safety and removing barriers to care

Promoting client safety: home, work, lifestyle, environment, danger/warning signs of pregnancy Removing barriers: Social Economic factors, lack of insurance, inability to pay, lack of free prenatal service, limit access to prenatal care for economically poor women, limited or expensive transportation, small children, cultural

Psychologic changes and concerns of a mother at 2nd Trimester

Aware of that the pregnancy can be recognized by others Acceptance of pregnancy Maternal role attainment: fetus movement fosters internalization and fantasy Fantasies: binding to infants Relationship with mother Body image: begins to view fetus as separate form own body, change the perception of body boundary as protective barrier to fetus

Question
The nurse should assess for which developmental task of the pregnant women in her third trimester? a. Bonding to the fetus in preparation for birth b. Accepting the fetus as a wanted responsibility c. Understanding the baby is an independent being d. Preparing to separate from the fetus through the birth process

Question-DM mother
The nurse teaches the newly pregnant diabetic the importance of self glucose monitoring in the first trimester to prevent: a. Hypoxia in the fetus b. The onset of diabetes in fetus c. Unusually large fetal development d. Teratogenic effects of hyperglycemia

Question- Preterm Labor


Magnesium Sulfate may be prescribed as a tocolytic drug because one of the expected actions is: a. Promoting diuresis b. Lowering blood pressure c. Inducing sedation and rest d. Promoting smooth muscle relaxation

Pain during labor

Analgesia: demerol (meperidine) Sedative: Seconal and Nembutal Narcotic analgesics: Fentanyl, Stabol Anesthesia: Marcaine (Bupavacaine) Alfenta (Alfentani)

Epidural Block

Give to women in 2-4 cm Cx dilation Giving anesthesiologist into epidual space at L-2, L-3, L-4 or L-5 Provide pain relief in lower part of body Labor stimulation by Oxytocin may need Prevent Hypotensive effect (500-1000 ml Lactated Ringers) Monitoring uterus contraction and fetus condition

Side Effects of Epidural Analgesia

Respiratory depression in newborn (Narcan) Pruitus (itching) Nausea and vomiting Urinary retention Hypotensive Affect labor process, unable to push during second stage of labor (assessment important)

Question
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: a. Slow the rate of IV infusion to avoid overload b. Retake the BP, initial hypotension is expected c. Begin oxygen by face mask, lower head, elevate legs. d. Call back anesthesiologist to deal with the condition

Induction or Augmentation of Labor

Induction: starting labor artificially by oxytocin Augmentation: stimulation of labor once it has begun naturally. Amniotomy: color of the amniotic fluid Assess risk: frequency of contraction, maternal tolerance, pain, fetus well-being, discomfort, progress of labor, complication

Lamaze Technique Question


The nurse teaching the Lamaze technique evaluates her success when the couple do the following: a. Break the fear/tension/pain cycle b. Bond successfully with the newborn c. Use positive feedback with each other during labor d. Maintain control during labor by their techniques of breathing and relaxation

Question (pain and childbirth class)


In developing childbirth classes the nurse plans to include techniques that normally minimize pain perception, which of these are inappropriate? a. Using muscle relaxation methods b. Invalidating the perception of pain c. Refocusing attention on another subject d. Implementing anxiety reduction techniques

In developing childbirth classes the nurse plans t include techniques that normally minimize pain perception, which of these are inappropriate? a. Using muscle relaxation methods b. Invalidating the pain perception c. Refocusing attention on another subject d. Implementing anxiety reduction techniques

Vaginal Birth After Cesarean Section (VBAC)

Repeat CS in USA 80% Fear of weakening the uterine scare Twice Maternal Risk in C/S than in Vaginal birth Qualification: primary cesarean not due to pelvic factors. Classic uterine incision??? Support of staff and womens desire to have vaginal birth are optimal factor for trying VBAC

Question
When membranes rupture spontaneously during labor, the nurse at the bedside must immediately: a. Monitor fetal heart rate b. Change the bed ped and give peri care c. Increase the flow rate of intravenous fluid d. Report the color and consistency of the fluid

Question
During labor, while lying supine in bed, Millie M. States she feels dizzy and weak, vital signs show an elevated pulse and lowered BP, the nurse should first: a. Notify the physician b. Check for vaginal bleeding c. Apply oxygen by mask at 10 L/min d. Rotate her to the left side-lying position

Question
Five hours prior to arriving at the DR, your clients amniotic membranes ruptured, which is a priority in the nursing planning? a. Monitoring urinary output hourly b. Providing frequent perineal care c. Increasing fluid intake intravenously d. Assessing temperature at least every 2 hours

Question
During transitional labor, when the fetal heart rate tracing shows a drop of 50 beats for 20 seconds and the rate returns to baseline, which is the first nursing action? a. Call for physician at once b. Turn client toward the left lateral position c. Position client to relieve pressure on the cord d. Do nothing, continue to observe since there is a rapid return to baseline

Postpartum Lactation

Colostrum: contain Immunoglobulins G and A (Ig G, Ig A) to protect newborns gastrointestinal System Secretion stage: prolactin hormone Let-down reflex: Neurohormonal Reflex primary responds to infants sucking, posterior pituitary gland secretes oxytocin.

Question hypoglycemia newborn


Which would indicate to the nurse that the newborn may be hypoglycemic? a. Hyperthemia with flushed skin b. Residual tremors after movement c. Vigorous sucking on nipple or on fist d. Frequent loose stools

Please Keep your good work and study hard, maternalinfant nursing is an interesting subject for you to learn!