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Prenatal Care – Module A NUR 106 Spring, 2005. Anatomical Landmarks Female Male.

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Presentation on theme: "Prenatal Care – Module A NUR 106 Spring, 2005. Anatomical Landmarks Female Male."— Presentation transcript:

1 Prenatal Care – Module A NUR 106 Spring, 2005

2 Anatomical Landmarks Female Male

3 External Structures

4 Internal Structures

5 Midsagital View

6 Uterus

7 Uterine Ligaments

8 Pelvic Bones

9 Female Pelvis

10 Pelvic Types

11 Muscles of the Pelvic Floor

12 Male: External and Internal Structures

13 Testis

14

15 Sperm

16 Female Reproductive Cycle Ovulation Menstruation Menarche Climacteric Menopause

17 Female Reproductive Cycle

18 Conception and Fetal Development Nine Month Miracle Miracle of Life Internet sites

19 Conception Fertility Sexual intercourse Pregnancy

20 Genetics Chromosomes Autosomal Sex Chromosomal syndromes Modes of inheritance

21 Patterns of Inheritance Dominant Recessive X-linked

22 Nursing Responsibilities Identify families at risk Education Liaison Support / Crisis intervention Continuity of care

23 Teratogens Tobacco Alcohol Marijuana Cocaine Heroin Anticonvulsants Anticoagulants Acne medications

24 Reproductive Ethics Maternal-fetal conflict Abortion Intrauterine fetal surgery Reproductive assistance Embryonic stem cell research Human genome project Cord blood banking

25 Fertilization One spermatozoon enters the ovum Two nuclei containing the parents’ chromosomes merge Occurs in the outer third of the fallopian tube Sex is determined

26 Multifetal Pregnancy Dizygotic twinning -- fraternal Monozygotic twinning -- identical

27 Implantation Nidation Gradual process Occurs between 6 th / 7 th and 10 th days Upper part of posterior uterine wall Placenta develops

28 Fertilization and Implantation

29 Amniotic Membranes Amnion (inner) Chorion (outer) Enclose fetus in amniotic fluid Protects fetus from infectious organisms

30 Amniotic Sac

31 Amniotic Fluid Clear, slightly yellow, alkaline fluid Approximately 1 liter at term Derived from Maternal plasma Cells of the amnion Fetal fluids from lung, skin, fetal urine

32 Functions of Amniotic Fluid Cushions fetus from trauma Facilitates fetal movement Facilitates symmetrical growth Regulates intrauterine temperature Provides source of oral fluid Cushions umbilical cord Receptacle for fetal substances

33 Placenta / Function Fully functional by week 12 Respiration Nutrition Waste removal Protection Endocrine

34 Placenta

35 Placenta After Delivery

36 Umbilical Cord One vein Two arteries Wharton’s jelly Amnion

37 Placenta and Cord

38 Umbilical Cord

39 12 weeks

40 18 Weeks

41 4 Months

42 5 Months

43

44 30 Weeks

45 40 Weeks

46 Fetal Development Preembryonic or ovum Embryonic Fetal

47 Fetal Circulation Ductus venosus Ductus arteriosus Foramen ovale

48 Fetal Circulation

49 Factors Affecting Fetal Development Exposure to teratogens Maternal health habits and lifestyle Paternal health habits and exposure to environmental influences

50 Physiological Changes During Pregnancy Uterus Ligaments Cervix Chadwick’s Goodell’s Hegar’s Breast Montgomery tubercles Skin

51 Circulatory System Increases up to 50% Pseudoanemia Iron requirements increased Increase in size Blood pressure changes Fibrinogen increases Mechanical circulatory effects

52 Supine Hypotension Syndrome

53 Respiratory System Thoracic cage Oxygen consumption increases Hyperventilation Respiratory alkalosis Mucosal edema

54 Digestive System Nausea / vomiting Constipation Flatulence / heartburn Gallstones

55 Urinary System Kidneys Function increases Renal threshold for sugar reduced Bladder and ureters Blood supply increased Pressure Atonia

56 Joints, Bones, Teeth, and Gums Pelvic cartilages Gait Uterus Posture changes Teeth Gums

57 Endocrine System Placenta HCG HPL Estrogen Progesterone Pituitary Adrenal Thyroid

58 Signs of Pregnancy Presumptive – Subjective Probable – Objective Positive -- Diagnostic

59 Signs of Pregnancy: S, O, or D Amenorrhea Goodell’s sign Fetal heart sounds Urinary frequency Positive pregnancy test Nausea and vomiting Enlargement of the abdomen Quickening Palpable fetal movements Braxton Hicks contractions

60 How would you explain the differences between the subjective (presumptive), objective (probable), and diagnostic (positive) signs of pregnancy to an expectant mother?

61 Maternal Psychosocial Changes First trimester Ambivalent Second trimester Baby becomes real Maternal introspection Third trimester Begins to think of baby as separate being Restless Self-centered

62 Rubin’s Maternal Tasks Seeking safe passage Securing acceptance Learning to give of self Committing self to child

63 Paternal Psychosocial Changes First trimester Excitement over virility Financial concerns Energetic Exhibit symptoms with wife Second trimester More confident Concerns about wife’s changes / introspection Third trimester Rivalry with fetus Interest in himself Fantasizes about child

64 Factors Affecting Psychological Response Body image Personal characteristics Financial situation Cultural expectations Emotional security Support from significant others Changes in sexuality Role of the father and siblings

65 Preparation for Parenthood Preconception Childbearing decisions Prenatal education Childbirth preparation

66 Childbirth Education Provides information on pregnancy and childbirth to facilitate optimal decision making Classes for special groups Importance of exercise during pregnancy Selection of birthing process Infant care

67 First Trimester Physical and psychosocial changes of pregnancy Self-care in pregnancy Protecting and nurturing the fetus Choosing a care provider and birth setting Prenatal exercise Relief of common early pregnancy discomforts

68 Second Trimester Planning for breast-feeding Sexuality in pregnancy Relief of common later-pregnancy discomforts

69 Third Trimester Preparation for childbirth Development of a birth plan Relaxation techniques Postpartum self-care Infant stimulation Infant care and safety

70 Goals of Prenatal Care Safe birth Health promotion Self-care Provide physical care Provide anticipatory guidance

71 Risk Factors / Reproductive Outcomes Maternal age Parity Socioeconomic status Ethnicity Geographic factors Behavioral and Lifestyle risks Health risks Previous pregnancies

72 Role of Nurse Physical assessment Identify and reevaluate risk factors Teach self-care Nutrition counseling Promote family’s adaptation to pregnancy

73 Prenatal Visits Every 4 weeks for first 28 to 32 weeks Every 2 weeks from 32 to 36 weeks Every week from 36 to 40 weeks

74 Terminology Gravida Nulligravida Primigravida Multigravida Para Primipara Multipara Nullipara Abortion Gestational age Fertilization age

75 Nomenclature G= number of pregnancies T = number of term deliveries P = number of preterm deliveries A= number of abortions L = number of living children M = number of multiple births

76 Nägele’s Rule First Day of Last Menstrual Period Minus 3 months Plus 7 days

77 Identify the causes and interventions for each discomfort of pregnancy: Heartburn Hemorrhoids Urinary frequency Nausea / vomiting Leg cramps Vaginal discharge Fatigue Backache Constipation Varicose veins Edema Dyspnea

78 Why is a positive pregnancy test not a positive sign of pregnancy?

79 Routine Lab Tests Blood grouping Rh factor and antibody screen CBC H & H VDRL, RPR, or STS Rubella titer TB skin test Hg electrophoresis HIV screen Hepatitis B screen UA PAP test Cervical culture MSAFP Maternal blood glucose

80 Prenatal Laboratory Tests: Normal or Abnormal ? Hemoglobin 13.6 g/dL Hematocrit 35% Rubella titer 1:6 WBC 6,200/ mm 3 Sickle Cell screen negative

81 Prenatal Self-Care Measures Breast tenderness Leg cramps Nausea Constipation Backache

82 Risk Factors Definition Social / Personal Preexisting medical disorders Obstetric considerations Problems associated with current pregnancy

83 Prenatal Diagnostic Studies Ultrasound Estriol: Increases with fetal growth Amniotic Fluid Amniocentesis Lecithin / sphingomyelin ratio Fern test Nitrazine test Kick test Chorionic villus sampling Alpha feto protein level

84 Level I Ultrasound Basic Detect gestational sac (5 weeks after LMP) Identify number of fetuses Document fetal life Detect gross fetal structural anomalies Estimate gestational age Determine fetal position Locate the placenta Estimate amniotic fluid volume Evaluate maternal pelvic masses

85 Level II Ultrasound Evaluate gestational age Measure fetal growth Perform specific examinations of the brain, heart, kidney, and cord insertion Quantify amniotic fluid volume Determine placental location Performed after 18 weeks

86 List two advantages of prenatal ultrasound assessment for the mother and fetus.

87 Tests of Fetal Well-Being Ultrasound Amniocentesis Nonstress Test (NST) Contraction Stress Test (CST) Breast Self-Stimulation Test (BSST)

88 Danger Signs in Pregnancy C =Chills and fever Cerebral disturbances A = Abdominal pain B = Blurred vision Blood pressure Bleeding S = Swelling Sudden escape of fluid

89 Nutrition During Pregnancy Choose foods from food guide pyramid Increase of 300 calories / day Calorie needs greater in last two trimesters Encourage diet high in folic acid with supplements Calcium needs increase nearly 50% Heavy demand for iron for fetal stores Drink 8 to 10 glasses of water / day

90 Food Guide Pyramid

91 Vegetarianism Need ample and complete proteins from dairy products and eggs Protein from brown rice and whole wheat, legumes, nuts, cooked and fresh vegetables and fruits Vitamin B 12 supplement

92 Lactose Intolerance Abdominal distention, discomfort, nausea, vomiting, loose stool, cramps May tolerate milk in cooked form Cheese and yogurt Lactase may be prescribed Lactase-treated milk Lactose-free products

93 Pica Non-nutritive eating Associated with poverty and inadequate diets Iron deficiency anemia

94 Weight Gain Normal: pounds Underweight: pounds Overweight: pounds

95 Uterine Growth During Pregnancy F

96

97 What is the average pattern of weight gain during each trimester of pregnancy?

98 Maternal Weight Gain Distribution Fetus, placenta, amniotic fluid11 pounds Uterus 2 pounds Increased blood volume 3 pounds Breast tissue 3 pounds Maternal stores 5-10 pounds Total pounds

99 Medications Prenatal vitamins Iron supplements Folic Acid Antacids

100 Case Study A client, who is a primigravida in her second trimester, has come in for a scheduled prenatal visit. When the nurse asks how things are going, the client replies, “Not very well. It seems like I’m just falling apart. I have heartburn after I eat, my ankles swell, I’m constipated all the time, and I think I may be getting hemorrhoids.”


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