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MATERNAL NEWBORN NURSING
REVIEW OF REPRODUCTIVE A&P, FETAL CONCEPTION AND DEVELOPMENT ANTEPARTUM TERMINOLOGY ANTEPARTUM ASSESSMENT PHYSIOLOGICAL CHANGES IN PREGNANCY PSYCHO-SOCIAL CHANGES IN PREGNANCY MATERNAL NUTRITION ASSESSMENT OF FETAL WELL BEING
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MODULE 1 PART 1 REVIEW OF REPRODUCTIVE ANATOMY AND PHYSIOLOGY
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REVIEW REPRODUCTIVE A&P, FETAL CONCEPTION & DEVELOPMENT
THIS WILL NOT BE COVERED IN THIS LECTURE—BE PREPARED TO ANSWER REVIEW QUESTIONS IN CLASS THE QUIZ IN CLASS 1 WILL FOCUS ON CHANGES IN PREGNANCY AND TERMINOLOGY
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Review of Reproductive A&P
External Genitals Internal Reproductive Organs Vagina Uterus Uterine corpus Cervix Uterine ligaments Fallopian Tubes Ovaries
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Figure 2–2 Female internal reproductive organs.
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Figure 2–4 Structures of the uterus.
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REVIEW OF REPRODUCTIVE A&P
UTERINE LIGAMENTS ROUND LIGAMENTS OVARIAN LIGAMENTS CARDINAL LIGAMENTS INFUNDIBULOPELVIC LIGAMENT UTEROSACRAL LIGAMENT
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Figure 2–6 Uterine ligaments.
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Figure 2–3b Blood supply to vagina, ovaries, uterus, and fallopian tube.
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Figure 2–3a Blood supply to internal reproductive organs
Figure 2–3a Blood supply to internal reproductive organs. Pelvic blood supply.
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Figure 2–5a Uterine muscle layers. Muscle fiber placement.
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MODULE 1 PART 2 REVIEW OF REPRODUCTIVE A & P
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PELVIC STRUCTURE Innominate bones ILIUM ILIAC CREST ISCHIUM
ISCHIAL TUBEROSITY ISCHIAL SPINES PUBIS SYMPHYSIS PUBIS Sacrum SACRAL PROMOTORY, SACROILIAC JOINTS Coccyx
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REVIEW OF REPRODUCTIVE A&P
PELVIC DIVISION TRUE PELVIS INLET PELVIC CAVITY OUTLET
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Figure 2–8 Pelvic bones with supporting ligaments.
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Figure 2–10a Female pelvis
Figure 2–10a Female pelvis. False pelvis is shallow cavity above the inlet; true pelvis is deeper portion of cavity below the inlet.
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Figure 2–11 Pelvic planes: coronal section and diameters of the bony pelvis.
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REVIEW OF REPRODUCTIVE A&P
PELVIC DIAPHRAGM LEVATOR ANI COCCYGEAL MUSCLES DEEP FASCIA PELVIC FLOOR MUSCLES ILLIOCOCCYGEUS PUBOCOCCYGEUS, COCCYGEUS PUBORECTALIS, PUBORECTALIS PUBOVAGINALIS
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Figure 2–9 Muscles of the pelvic floor
Figure 2–9 Muscles of the pelvic floor. (The puborectalis, pubovaginalis, and coccygeal muscles cannot be seen from this view.)
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REVIEW OF REPRODUCTIVE A&P
BREASTS NIPPLE AREOLA TUBERCLES OF MONTGOMERY LACTIFEROUS DUCTS ADIPOSE, GLANDULAR, FIBROUS TISSUE COOPER’S LIGAMENTS
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Figure 2–12 Anatomy of the breast: sagittal view of left breast.
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MODULE 1 PART 3 CONCEPTION
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MATURATION OF OVARIAN FOLLICLE
OVULATION CORPUS LUTEUM NEUROHUMORAL RESPONSE HYPOTHALMUS RELEASES GONADATROPIN-RELEASING HORMONE TO PITUITARY FROM RESPONES FROM CNS ANTERIOR PITUITARY THEN SECRETES FSH AND LH
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FEMALE REPRODUCTIVE CYCLE
OVARIAN CYCLE FOLLICULAR PHASE LUTEAL PHASE FEMALE HORMONES ESTROGEN PROGESTERONE PROSTAGLANDINS UTERINE CYCLE (MENSTRUAL)
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Figure 2–13 Female reproductive cycle: interrelationships of hormones with the four phases of the uterine cycle and the two phases of the ovarian cycle in an ideal 28-day cycle.
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Figure 2–14 Various stages of development of the ovarian follicles.
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REVIEW OF CONCEPTION AND FETAL DEVELOPMENT
CELLULAR DIVISION MITOSIS MEIOSIS OOGENESIS SPERMATOGENESIS PRE-FERTILIZATION CAPACIATION ACROSOMAL REACTION FERTILIZATION
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PREEMBRYONIC STAGE CELLULAR MULTIPLICATION CLEAVAGE MORULA BLASTOCYST TROPHOBLAST IMPLANTATION CHANGES IN ENDOMETRIUM DECIDUA CAPSULARIS DECIDUA BASALIS DICIDUA VERA
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Figure 3–2a Sperm penetration of an ovum
Figure 3–2a Sperm penetration of an ovum. The sequential steps of oocyte penetration by a sperm are depicted moving from top to bottom. Source: Scanning electron micrograph from Nilsson, L. (1990). A child is born. New York: Dell Publishing.
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Figure 3–1b Each spermatogonium produces four haploid spermatozoa.
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Figure 3–5 Formation of primary germ layers
Figure 3–5 Formation of primary germ layers. A, Implantation of a 71⁄2-day blastocyst in which the cells of the embryonic disc are separated from the amnion by a fluid-filled space. The erosion of the endometrium by the syncytiotrophoblast is ongoing. B, Implantation is completed by day 9, and extraembryonic mesoderm is beginning to form a discrete layer beneath the cytotrophoblast. C, By day 16 the embryo shows all three germ layers, a yolk sac, and an allantois (an outpouching of the yolk sac that forms the structural basis of the body stalk, or umbilical cord). The cytotrophoblast and associated mesoderm have become the chorion, and chorionic villi are developing. Source: Adapted from Marieb, E. N. (1998).
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Figure 3–4 During ovulation, the ovum leaves the ovary and enters the fallopian tube. Fertilization generally occurs in the outer third of the fallopian tube. Subsequent changes in the fertilized ovum from conception to implantation are depicted.
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MODULE 1 PART 4 REVIEW OF CONCEPTION AND FETAL DEVELOPMENT
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CELLULAR DIFFERENTIATION
THREE PRIMARY GERM LAYERS ECTODERM MESODERM ENDODERM EMBRYONIC MEMBRANES AMNION CHORION AMNIOTIC SAC
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REVIEW FETAL DEVELOPMENT
AMNIOTIC FLUID UMBILICAL CORD PLACENTA
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REVIEW OF FETAL DEVELOPMENT
EMBRYONIC AND FETAL DEVELOPMENT EMBRYONIC STAGE—DAY 15 T0 8TH WEEK FETAL STAGE—8TH WEEK TO BIRTH
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Figure 3–10 Vascular arrangement of the placenta
Figure 3–10 Vascular arrangement of the placenta. Arrows indicate the direction of blood flow. Maternal blood flows through the uterine arteries to the intervillous spaces of the placenta and returns through the uterine veins to maternal circulation. Fetal blood flows through the umbilical arteries into the villous capillaries of the placenta and returns through the umbilical vein to the fetal circulation.
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Figure 3–7 Early development of primary embryonic membranes
Figure 3–7 Early development of primary embryonic membranes. At 41⁄2 weeks, the decidua capsularis (placental portion enclosing the embryo on the uterine surface) and decidua basalis (placental portion encompassing the elaborate chorionic villi and maternal endometrium) are well formed. The chorionic villi lie in blood-filled intervillous spaces within the endometrium. The amnion and yolk sac are well developed. Source: Adapted from Marieb, E. N. (1998).
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Figure 3–10 Vascular arrangement of the placenta
Figure 3–10 Vascular arrangement of the placenta. Arrows indicate the direction of blood flow. Maternal blood flows through the uterine arteries to the intervillous spaces of the placenta and returns through the uterine veins to maternal circulation. Fetal blood flows through the umbilical arteries into the villous capillaries of the placenta and returns through the umbilical vein to the fetal circulation.
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Figure 3–7 Early development of primary embryonic membranes
Figure 3–7 Early development of primary embryonic membranes. At 41⁄2 weeks, the decidua capsularis (placental portion enclosing the embryo on the uterine surface) and decidua basalis (placental portion encompassing the elaborate chorionic villi and maternal endometrium) are well formed. The chorionic villi lie in blood-filled intervillous spaces within the endometrium. The amnion and yolk sac are well developed. Source: Adapted from Marieb, E. N. (1998).
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Figure 3–6 Endoderm differentiates to form the epithelial lining of the digestive and respiratory tracts and associated glands. Source: Adapted from Marieb, E. N. (1998).
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Figure 3–12 The actual size of a human conceptus from fertilization to the early fetal stage. The embryonic stage begins in the third week after fertilization; the fetal stage begins in the ninth week. Source: Adapted from Marieb, E. N. (1998).
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MODULE 1 PART 5 REVIEW QUESTIONS
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REVIEW QUESTIONS WHAT IS THE SIGNIFICANCE OF THE ENDOMETRIAL (MUCOSAL) LAYER OF THE UTERUS? THE UTERUS IS MADE UP OF WHAT TYPE OF MUSCLE? ESTROGEN IS SECRETED BY THE_______? PROGESTERONE IS SECRETED BY THE_______? WHAT IS THE FUNCTION OF FSH AND LH? DESCRIBE MEIOSIS.
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REVIEW QUESTIONS WHERE DOES FERTILIZATION OCCUR?
THE BLASTOCYST DEVELOPS INTO THE ______. THE TROPHOBLAST DEVELOPS INTO THE ____. THE PLACENTA DEVELOPS FROM THE ______. WHICH SYSTEMS/STRUCTURES DEVELOP FROM THE MESODERM LAYER?
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NAME THREE FACTORS THAT AFFECT FETAL DEVELOPMENT.
WHAT IS THE ROLE OF THE BROAD AND ROUND LIGAMENTS? WHAT IS THE UPPER PORTION OF THE UTERUS CALLED? WHATS CHANGES OCCUR IN THE FUNCTION OF THE OVARIES AT ABOUT THE TH WEEK OF PREGNANCY?
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MODULE 1 PART 6A PHYSIOLOGICAL CHANGES IN PREGNANCY
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PHYSIOLOGICAL CHANGES IN PREGNANCY
GROWTH OF PLACENTA INTEGUMENTARY RESPIRATORY ENDOCRINE RENAL CARDIOVASCULAR GI GU REPRODUCTIVE MUSCULOSKELETEL
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REPRODUCTIVE SYSTEM PLACENTA AMNION CHORION UMBILICAL CORD AMNIOTIC FLUID
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REPRODUCTIVE SYSTEM PLACENTAL FUNCTION METABOLIC TRANSPORT ENDOCRINE
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REPRODUCTIVE SYSTEM OVARIES
STOP PRODUCING OVA. CORPUS LUTEUM IS ACTIVE WEEKS INTO PREGNANCY TO PRODUCE ESTROGEN AND PROGESTERONE. THEN WHAT HAPPENS? BREASTS INCREASED VASCULARITY AND SIZE HYPERTROPHY OF MAMMARY AVEOLI BECOME MORE NODULAR; NIPPLES ENLARGE PIGMENTATION OF AREOLA; COLUSTRUM
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REPRODUCTIVE SYSTEM UTERUS
INCREASE IN SIZE, WEIGHT, AND VOLUME CAPACITY FIBROUS TISSUE INCREASES INCREASE IN BLOOD FLOW CERVIX GOODALL’S SIGN, CHADWICK’S SIGN DEVELOPMENT OF MUCOS PLUG
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REPRODUCTIVE SYSTEM VAGINA MUCOSA THICKENS INCREASE IN SECRETIONS
LOOSENING OF CONNECTIVE TISSUE—WHY?
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RESPIRATORY SYSTEM O2 CONSUMPTION INCREASES BREATHING CHANGES FROM ABDOMINAL TO THORACIC INCREASED VACULARITY DIAPHRAGM ELEVATES
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CARDIOVASCULAR SYSTEM
BLOOD VOLUME INCREASES DECREASE IN SYSTEMIC AND PULMONARY RESISTANCE IN THIRD TRIMESTER INCREASE IN CARDIAC OUTPUT, PULSE INCREASE (10-15 BPM) Why? SVR DECREASE IN THIRD TRIMESTER
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MUSCULOSKELETAL SYSTEM
PELVIC JOINTS RELAX CENTER OF GRAVITY CHANGES METABOLISM EXTRA WATER, FAT, AND PROTEIN STORED FATS ARE MORE COMPLETELY ABSORBED BMR INCREASE (CAN BE UP TO 25%)
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MODULE 1 PART 6B PHYSIOLOGICAL CHANGES IN PREGNANCY
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GASTRONTESTINAL SMOOTH MUSCLE RELAXATION—RELATED TO PROGESTERONE INFLUENCE
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RENAL FREQUENCY DILATATION OF KIDNEYS, URETERS ELONGATE
INCREASED GFR, CREATININE CLEARANCE AND RENAL PLASMA—FLOW-WHY? GLYCOSURIA MAY OCCUR
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INTEGUMENTARY HYPERPIGMENTATION STRIAE CHLOASMA (MELASMA) VASCULAR SPIDER NEVI DECREASED HAIR GROWTH HYPERACTIVE SWEAT AND SEBACEOUS GLANDS
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ENDOCRINE SYSTEM THYROID—T4 AND BMR INCREASE (25% BY TERM), TSH DECREASES THYROID—GLAND ENLARGES, INCREASED IODINE METABOLISM, INCREASED VASCULARITY PITUITARY—FSH AND LH SUPPRESSED, SECRETION OF PROLACTIN, OXYTOCIN, AND VASOPRESSION PANCREAS—INSULIN PRODUCTION INCREASE TO COMPENSATE FOR PLACENTAL HORMONE INSULIN ANTAGONISTS
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ENDOCRINE SYSTEM CONCENTRATION OF PARATHYROID HORMONE INCREASES—WHY IS THIS SIGNIFICANT? INCREASED ALDOSTERONE ADRENALS—LITTLE CHANGE
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ENDOCRINE SYSTEM ESTROGEN
LIST THREE ACTION OF ESTROGEN DURING PREGNANCY ESTROGEN IS PRIMARILY EXCRETED BY THE ______ DURING PREGNANCY
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ENDOCRINE SYSTEM PROGESTERONE LIST THREE ACTIONS OF PROGESTERONE DURING PREGNANCY
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ENDOCRINE SYSTEM hCG--(HUMAN CHORIOGONADATROPIC HORMONE)--STIMULATES PROGERTERONE AND ESTROGEN TO MAINTAIN PREGNANCY hPL—(HUMAN PLACENTAL LACTOGEN)—DECREASES MATERNAL METABOLISM FOR GLUCOSE (INSULIN ANTAGONIST) PROSTGLANDINS
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ENDOCRINE SYSTEM RELAXIN DECREASES UTERINE CONTRACTILITY SOFTENS CERVIX SOFTENS JOINTS REMODELS COLLAGEN
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MODULE 1 PART 7 PSYCHOLOGICAL CHANGES IN PREGNANCY
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MOTHER’S RESPONSE TO PREGNANCY
AMBIVALENCE ACCEPTANCE INTROVERSION MOOD SWINGS FEAR CHANGES IN BODY IMAGE ANTEPARTUM DEPRESSION?
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FATHER’S RESPONSE TO PREGNANCY
CONFUSED BY PARTNER’S MOOD SWINGS FEELS LEFT OUT RESENTS ATTENTION GIVEN YO THE WOMAN RESENTS CHANGES IN THEIR RELATIONSHIP NEEDS TO RESOLVE CONFLICTS ABOUT FATHERING
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MODULE 1 PART 8 ANTEPARTUM TERMINOLOGY
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GESTATION ANTEPARTUM INTRAPARTUM POSTPARTUM PRETERM LABOR POSTTERM LABOR
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GRAVIDA NULLIGRAVIDA PRIMIGRAVIDA MULTIGRAVIDA
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PARA NULLIPARA PRIMIPARA MULTIPARA
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ABORTION: WEEKS PRE-TERM: WEEKS TERM: 39 WEEKS, 1 DAY- 42 WEEKS
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TPAL T--NUMBER OF TERM PREGNANCIES P--NUMBER OF BIRTHS AFTER 20 WEEKS A—NUMBER OF ABORTIONS L—NUMBER OF LIVING CHILDREN
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G/TPAL EXERCISES G T P A L G G G G
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MODULE 1 PART 9A ANTEPARTUM PHYSICAL AND PSYCHO-SOCIAL ASSESSMENT
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ANTEPARTUM PHYSICAL AND PSYCHO-SOCIAL ASSESSMENT
CULTURE FINDINGS RELATED TO PREGNANCY PHYSICAL ASSESSMENT RISK FACTORS CLIENT PROFILE ECONOMICS ENVIRONMENT SUPPORT SYSTEM FAMILY FUNCTION EDUCATIONAL NEEDS
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CULTURAL BELIEFS AND PRACTICE ASSESSMENT IN ANTEPARTUM PERIOD
HOME REMEDIES NUTRITION ALTERNATIVE HEALTH CARE PROVIDERS FAMILY SUPPORT EXERCISE SPIRITUALITY
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CULTURAL CONSIDERATIONS/ASSESSMENT IN ANTEPARTUM PERIOD
VIEW OF PREGNANCY SELF CARE PRACTICES PAIN CHILDBIRTH PRACTICES CARE OF THE NEWBORN POST PARTUM
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SIGNS OF PREGNANCY SUBJECTIVE (PRESUMPTIVE) OBJECTIVE (PROBABLE)
DIAGNOSTIC (POSITIVE)
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DUE DATE EDD, EDC, EDB NAEGLE’S RULE—SUBTRACT 3 MONTHS FROM FIRST DAY OF LAST MENSTRUAL PERIOD AND ADD 7 DAYS EXAMPLE: LMP OCT. 12—EDB---JULY 19
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CLIENT PROFILE CURRENT PREGNANCY PAST PREGNANCY CURRENT MEDICAL/SUGICAL HISTORY GYN HISTORY FAMILY MEDICAL HISTORY RELIGIOUS, SPIRITUAL, CULTURAL HISTORY OCCUPATIONAL HISTORY PERSONAL INFORMATION—(PSYCHOSOCIAL)
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ANTEPARTUM RISK FACTORS
FACTORS RELATED TO: ECONOMICS ENVIRONMENT CURRENT HEALTH STATUS/PRACTICES AGE NUTRITION CHILDBIRTH HISTORY SOCIAL ISSUES PYSCHOLOGICAL STATUS
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MODULE 1 PART 9B ANTEPARTUM PHYSICAL AND PSYCHOSOCIAL ASSESSMENT
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ANTEPARTUM PHYSICAL ASSESSMENT
VS UTERUS SKIN EXTERNAL GENITALS MOUTH, EARS, NECK CERVIX, VAGINA CHEST AND LUNGS ANUS AND RECTUM BREASTS LAB EVALUATION HEART ABDOMEN EXTREMITIES REFLEXES SPINE
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LAB EVALUATIONS INITIAL ANTEPARTUM VISIT
SCREENING TESTS CBC ABO AND Rh TYPING WBC WITH DIFFERENTIAL FIRST TRIMESTER ANEUPLOIDY STD SCREENING, HIV GLUCOSE RUBELLA TITER HEPATITS B SICKLE CELL PAP SMEAR
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PSYCHO-SOCIAL ANTEPARTUM ASSESSMENT
CULTURE PSYCHOLOGIC STATUS EDUCATIONAL NEEDS SUPPORT SYSTEMS FUNCTIONING OF FAMILY ECONOMIC STATUS ENVIRONMENT
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MATERNAL NUTRITION AVERAGE WEIGHT GAIN PATTERN OF WEIGHT GAIN
NUTRITIONAL REQUIREMENTS CALORIES PROTEIN
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MATERNAL NUTRITION FAT CARBS VITAMINS MINERALS CULTURAL CONSIDERATIONS
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MATERNAL NUTRITION VEGETARIANISM LACTOSE DEFICIENCY EATING DISORDERS
PICA ADOLESCENT WHAT TEACHING WOULD YOU DO FOR THESE ALTERATIONS/ CHANGES IN NUTRITION?
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ANTEPARTUM ASSESSMENT FETAL DEVELOPMENT
FUNDAL HEIGHT QUICKENING FETAL HEART RATE ULTRASOUND
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Figure 7–5 Approximate height of the fundus at various weeks of pregnancy.
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Figure 8–3 A cross-sectional view of fetal position when McDonald’s method is used to assess fundal height.
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MODULE 1 PART 10 ASSESSMENT OF FETAL WELL BEING
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NUCAL TRANSLUCENCY TESTING (NTT)
FETAL ACTIVITY ULTRASOUND TRANSABDOMINAL TRANSVAGINAL NUCAL TRANSLUCENCY TESTING (NTT) DOPPLER BLOOD FLOW STUDIES
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AMNIOCENTESIS (AMNIOTIC FLUID ANALYSIS)
EVALUATION OF FETAL HEALTH EVALUATION OF LUNG MATURITY CHORIONIC VILLI SAMPLING (CVS) WHAT IS THE ADVANTAGE OF THE CVS?
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TERATOGENESIS MEDICATIONS MATERNAL: NUTRITION VIRUS ALCOHOL RADIATION
COCAINE TOBACCO HYPERTHERMIA CAFFEINE MARIJUANA
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MODULE 1 PART 11 DANGERS/DISCOMFORTS IN PREGNANCY
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DANGER SIGNS OF PREGNANCY
VAGINAL BLEEDING LEAKAGE OF FLUID FROM VAGINA ABDOMINAL PAIN TEMP > 101 DIZZINESS, BLURRING OF VISION SEVERE HEADACHE EDEMA OF HANDS, FACE, FEET
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DANGER SIGNS OF PREGNANCY
PERSISTENT VOMITING MUSCULAR IRRITABILITY EPIGASTRIC PAIN OLIGURIA DYSURIA ABSENCE OF FETAL MOVEMENT
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DISCOMFORTS OF PREGNANCY
FIRST TRIMESTER NAUSEA AND VOMITING URINARY FREQUENCY FATIGUE BREAST TENDERNESS
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DISCOMFORTS OF PREGNANCY
INCREASED VAGINAL DISCHARGE NASAL STUFFINESS & EPITAXIS PTYALISM
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DISCOMFORTS OF PREGNANCY
SECOND & THIRD TRIMESTER HEARTBURN ANKLE EDEMA VARICOSE VEINS HEMORRHOIDS
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DISCOMFORTS OF PREGNANCY
CONSTIPATION BACKACHE LEG CRAMPS FAINTNESS
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DISCOMFORTS OF PREGNANCY
DYSPNEA FLATULENCE CARPAL TUNNEL SYNDROME DIFFICULTY SLEEPING ROUND LIGAMENT PAIN
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DISCOMFORTS OF PREGNANCY
DETERMINE WHICH SYSTEM IS RESPONSIBLE FOR EACH OF THE DISCOMFORTS OF PREGNANCY. EXPLAIN HOW THE PHYSIOLOGICAL CHANGES THAT OCCUR IN EACH SYSTEM DURING PREGNANCY CAN BE RESPONSIBLE FOR THE DISCOMFORTS. WHAT INTERVENTIONS WOULD YOU USE TO TREAT THE DISCOMFORTS? (EBP)
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SUBSEQUENT LAB EVALUATION
HEMOGLOBIN QUAD MARKER (15-20 WEEKS) INDIRECT COOMBS 50 G 1 HOUR GLUCOSE SCREEN URINALYSIS—GYCOSURIA, PROTEINURIA GROUP B STREP SCREENING (35-37 WEEKS)
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SELF CARE PROMOTION BATHING EMPLOYMENT TRAVEL ACTIVITY, REST
FETAL ACTIVITY MONITORING BREAST CARE CLOTHING
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SELF CARE PROMOTION DENTAL CARE IMMUNIZATIONS SEXUAL ACTIVITY
COMPLEMENTARY & ALTERNATIVE THERAPIES ABSTINENCE FROM ALCOHOL, TOBACCO, DRUGS PSYCHO-SOCIALSUPPORT
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