T4 MATERNAL #2

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BHAVES
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142674
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T4 MATERNAL #2
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2012-03-21 03:38:03
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T4 MATERNAL
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T4 MATERNAL #2
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  1. FETAL DEVELOPMENT
    • Fertilization - the union of the egg & sperm to form zygote & occurs in outer 1/3 of fallopian tube
    • Implantation - 6-10 days after conception

    • Intrauterine development has 3 stages:
    • Ovum - conception to day 14
    • Embryo - 15 days to 8 weeks
    • Fetal - 9 weeks until completion

    • 4 WEEKS - begin the Heartbeat
    • 8 WEEKS - hear the heartbeat
    • 12 WEEKS -
    • 16-20 WEEKS - feel the movement

    • 2 Positive Signs of Pregnancy
    • Fetal Heart Beat
    • Fetal Movement in Palpation
  2. THE PLACENTA
    • Produces hormones needed to maintain pregnancy - It does not produce ANTIBODIES
    • Performs the metabolic functions of RESPIRATION NUTRITION, EXCRETION, & STORAGE -> CAN DETOXIFY SOME DRUGS & CHEMICALS
  3. THE UMBILICAL CORD - 2 Arteries and 1 Vein
  4. SIGNS & SYMPTOMS OF PREGNANCY - Nausea & Vomiting
    • Quickening - Fetal movement at 16-20 weeks gestation
    • Striae Gravidarum - stretch marks - WILL GET LIGHTER AFTER DELIVERY
    • Hegar's Sign - softening & compressibility of lower uterus at 6-8 weeks pregnancy (-/+ signs)

    • Positive Signs:
    • Fetal Heart Sounds - Fetoscope or Doppler
    • Fetla Movement Palpated - ultrasound or x-ray exam
  5. PHYSIOLOGIC CHANGES IN PREGNANCY - HCG human chorionic gonadtropin - MOST PREGNANCY- rises in early pregnancy then drops second trimester
  6. PHYSIOLOGICAL MATERNAL CHANGES
    • 3RD Month - fetal heartbeat heard by SYMPHISIS PUBIS - BEST PLACE TO HEAR above pubic bone
    • 6TH Month - mild swelling in the ankles - CHECK FOR EDEMA EVERY ROUTINE TEST - check for Edema, Fundal HT, WT, V/S & Fetal Heart Tones

    BRAXTON-HICKS (fake contractions)--> will go away with walking take
  7. LABORATORY TESTS
    • HCG - markers for pregnancy --> can be detected in Serum & Urine
    • Serum Alpha-Fetoprotein (AFP) -->detects neural tube detects such as SPINA BIFIDA

    FOLIC ACID - improves pregnancy outcome by preventing certain complications.

    • TORCH -
    • Toxoplasmosis -risk if a CAT in the house --> domestic CATS are definitive hosts with Infection
    • Other Infections
    • Rubella
    • Cytomegalovirus
    • Herpes Virus
  8. HERPES SIMPLEX VIRUS - requires C-section prior to rupture of membranes
    • Diagnostic Tests
    • External Abdominal Ultrasound
    • Internal Transvaginal Ultrasound

    REACTIVE NST - FHR --> 15/15/15 15 beats for 15 seconds for 15 mi15 minutes

  9. NON STRESS TEST - Pt Teaching -->instruct the mother to drink a fluid, have a snack, or to touch or rock the abdomen to move the fetus
    • Diagnostic Tests
    • Contraction Stress Test (CST)
    • Negative CST (normal)
    • Positive CST (abnormal)
    • Biophysical Profile (BPP) - TOTAL 8-10 is normal --> BABY IS NOT DISTRESS
    • AFP- high levels associated with Neural Defects - SPINA BIFIDA
  10. HYDATIDIFORM MOLE - Gestational Trophoblastic Mole - appears as a BUNCH OF GRAPES - cellular growth, fast growing --> Maternal Blood will present with HIGH LEVELS OF HCG - (if high level of hcg it is a problem)
  11. DANGER SIGNS DURING PREGNANCY - PRIORITY -->First Prenatal Visit
  12. SPONTANEOUS ABORTION - use Term Miscarriage
  13. COMPLICATIONS OF PREGNANCY
    • ECTOPIC
    • Risk Factors: any factor that compromises tubal patency (PID,IUD >2 years) - (pt history)
    • Assess for UNILATERAL PAIN (abdominal pain) & VAGINAL BLEEDING --> + FOR PREGNANCY TEST
    • Gestational Trophoblastic Disease - GRAPE LIKE - clusters

    • GESTATIONAL TROPHOBLASTIC DISEASE
    • S/S: Rapid Uterine Growth, Vaginal Bleeding (sign of Mole)
  14. PLACENTA PREVIA
    3 TYPES
    Complete or Total: --> C-SECTION
    Incomplete or Partial - vaginal or MD's preference
    Marginal or Low-lying - vaginal or MD's preference
    • S/S:
    • PAINLESS BRIGHT RED VAGINAL BLEEDING & SOFT UTERUS WITH NORMAL HEART TONE

  15. COMPLICATINS OF PREGNANCY
    • ABRUPTIO PLACENTA
    • Surgical Emergency, Leading cause of Maternal Death --> WOMEN IS IN PAIN & UTERUS WILL BE BOARD LIKE

    • S/S:
    • Sudden onset, localized uterine PAIN, BOARD-LIKE ABDOMEN, FETAL DISTRESS
    • TX: C-section delivery
  16. COMPLICATIONS OF PREGNANCY
    • HYPEREMESIS GRAVIDARUM
    • Vomiting
    • Risk: Intrauterine Growth Restriction or Preterm Birth
    • After Dx will presume mother is treated and Expect Normal Baby delivery

    • S/S:
    • NPO for 24-48 hours, Monitor I/O, V/S, WT, mucus membranes --> clear diet; broth jello, ice pops tea
  17. COMPLICATIONS OF PREGNANCY
    • Gestational HTN (GH)/ Pregnancy Induced HTN (PIH)
    • High Risks include mother <19 or > 39 y.o.
    • S/S:
    • HTN, PROTEINURIA, EDEMA (mild eclamsia) VISUAL CHANGES

    • Gestation HTN - begins after 20th week of pregnancy
    • Mild Preeclamsia - Woman B/P of 140/90 or >; 1+/2+proteinuria
    • Severe Preeclampsia- sudden abdominal pain, woman has B/P is 160/100 mm Hg or >, or 3+ to 4+
    • PT will have abdominal pain & Vaginal Bleeding
    • CK for V/S, HEART TONE, & BLEED & I/O
    • Eclampsia - SEVERE --> Woman has a B/P of 160/100 or > 3+ to 4+ proteinuria --> PITTING EDEMA
    • BLURRED VISION - call MD asap
    • MAGNESIUM SO4 - PREVENT SEIZURES

    36 WEEKS - Bilateral Dependent Edema is expected
  18. COMPLICATIONS OF PREGNANCY
    • Gestational Diabetes
    • Ideal Blood Glucose 60-120 mm/dL
    • INSULIN ACTS LIKE GROWTH HORMONE

    Maternal Risk of: UTI due to GLYCOSURIA & KETOACIDOSIS

    • S/S:
    • Hunger THIRST frequent URINATION
    • Instruct perform DAILY KICK COUNTS - least invasive fetal check counts
  19. HEALTHCARE DURING PREGNANCY
    • Goals of Good Prenatal care:
    • Mental Wellness
    • Give Birth safely
    • Ensure a Healthy Baby
    • Total Gain During Pregnancy: 25-35 per week

    • PRENATAL VISITS:
    • Every 4 weeks for 1-28th weeks
    • Then every 2 weeks until 36 weeks
    • Then weekly until birth
    • Postpartum - at 4-6 weeks after birth; some like to see woman at 2 weeks Postpartum

    • INITIAL PRENATAL VISIT:
    • Establish schedule of Prenatal Visits - Highest Priority

    • RETURN PRENATAL VISITS
    • MD repeat STD testing at 36 weeks & Vaginal Culture B C-SECTION

    • Elimination & Hygiene - Daily Bowel Movement
    • Breast Care - COMFORTABLE SUPPORTIVE BRA
    • NO SOAP on the Nipples

    • REST:
    • Rest on her Left Side for at least 1 hour am/pm to reliver fetal pressure
    • Avoid sleeping or Lying on Back due to SUPINE HYPOTENSION SYNDROME
    • If to remain on back PLACE SMALL PILLOW OR TOWEL ROLL under one hip

    • TERATOGENS - cause Brith defects & learning abilities
    • Diseases - Rubella, Herpes, Toxoplasmosis, Syphilis
    • Tobacco - small babies
    • Alchohol - cause learning disabilities / cognitive impairment
  20. NUTRITION DURING PREGNANCY
    • Increase IRON, Folic Acid - DRINK O.J. helps absorb
    • ex:: BEEF SPINACH
    • CAFFEINE - harmful - avoid COFFEE, SOME TEAS MOST COLAS

    • WEIGHT GAIN DURING PREGNANCY
    • 25-35 LBS - gain entire pregnancy
    • 3-4 lbs weight gain in first trimester
    • 1 lbs /week for the last 2 trimester
  21. PRENATAL & CHILDBIRTH EDUCATION
    1st Trimester: - Discomforts - at 4 WEEKS BREAST SENSITIVITY/TENDERNESS

    2nd Trimester - FETAL MOVEMENT/ KICK COUNTS - least Invasive
  22. COMMON DISCOMFORTS - 8 weeks
    • Nausea & Vomiting - eat crackers - SUBSIDE WITHIN 9-12 WEEKS
    • Breast Tenderness - bra that provides support
    • Urinary Frequency - 1st & 3rd trimester
    • UTI - use cotton undies
    • Fatigue - more rest - go to bed early
    • Heartburn - small frequent meals
    • Constipation - inc. fluid exercise, fiber
    • SOB & Dyspnea - extra pillows, between 37-40 wks expected sign of late pregnancy
    • Lower Extremity Edema
    • Gingivitis - increase Hormones in the Body
    • Braxton- Hicks - false contraction --> go away when walking
    • Supine Hypotension - lay in side lying -> RECOMMEND LEFT SIDE

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