婦產(chǎn)科護(hù)理課件

1、Review of Maternal-Infant Nursing Trends in Maternal-Infant Nursing CareDevelopment standard of care, certification, advanced practice nursesHome Health care for postpartum women, discharge from Hops. 12-24 hours after delivery, high risk infants discharge home earlier than beforeConsumer involved i

2、n the childbearing care: Child birth class, sibling present, breast-feeding, birthing environment (LDR, LDRP), fathers involvement, parents leave option for family with newbornMaternal Nursing concerns areasPrenatal careLow birth weightMother and infant with HIV infectionAdolescent pregnancyDrug and

3、 substance abuse during pregnancySocial/family stress and impacts to pregnant women and familyUse and care for pregnant womenSpecial Issues in Womens Health Violence Sexual Transmitted Diseases: HIV/AIDS 86% of pediatric AIDS cases are transmitted through vertical transmission of HIVSubstance abuse

4、Other diseases: Heart diseases, cancer, osteoporosis, eating disordersThe Menstrual CycleOvarian 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 secretion2.

5、Ovulation: increase in body temperature (progesterone secretion), fern pattern of the cervical mucus, spinnbarkeit “elasticity of the ovulatory”due to secretion of the estrogen The Menstrual Cycle3.Luteal Phase: Corpus luteum and anterior pituitary gland will secret luteinizing hormones (the decreas

6、e in Estrogen and progesterone positive feedback to Hypothalamus and anterior pituitary- stimulating the secretion of FSH4. Premenstrual phase: Decline in estrogen and progesterone The Menstrual CycleEndometrial Cycle:Proliferative phaseSecretary phaseMenstrual phaseQuestionFSH stimulates which proc

7、esses in the menstrual Cycle? Thinking of endometriumMaturation of follicle Decrease in basal body temperatureIncrease in progesterone production Infertility CareInfertility affects 15-20% of the populations in the reproductive yearsTerms to be understood: Artificial inseminationEndometriosisLaparos

8、copyPrimary InfertilitySecondary InfertilityVaricoceleEndometriosis Terms related to Infertility TreatmentIn vitro Fertilization/embryo TransferGamete intrafallopian tube transfer (GIFT)Zygote Intrafallopian Transfer (ZIFT)Testing of infertility: Ovulatory Analysis Sperm AnalysisTesting of STDSTubal

9、 Patency testQuestionIn which phase of the menstrual cycle is thick, scant cervical mucus and an elevated BBT seen? Estrogenic phaseMenstrual PhaseOvulatory phaseLuteal PhaseNames of the infertility drugsClomiphene “Clomid”-risk of multiple ovulationhCG: to facilitate the ovulation , side effect ova

10、rian 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 coupleIdentify proble

11、ms and strengths: Self-esteem disturbance related to diagnosisPersonal Identity disturbance, related to unsuccessful infertility treatmentIneffective family coping, compromised live and decision making Nurse =supporter, advocate, counseling,Pregnancy TerminationLegal/ethical Decision making dilemmas

12、 Counseling regarding pregnancy terminationPsychological impact of pregnancy termination Risk and complication associated Grief/guilt/ambivalence/uncertainty feeling after terminating of pregnancy Sexually Transmitted DiseasesChamydia trachmatis infectionGonorrheaHuman PapillomavirusHerpes Simplex V

13、irus type 2 infectionCytomegalovirus infectionSyphilisVaginitisHuman Immunodeficiency Virus InfectionQuesitonWomen should be taught to be aware of early warning signs of HIV infection which are: DyspareuniaSevere dysmenorrheaOccasional Candida infectionRecurrent episodes of genital warts QuestionThe

14、 purpose of taking Tamoxifen after a mastectomy is to:Alleviate cancer painAct as hormonal replacement therapyBlock tissue uptake and utilization of estrogenDestroy any stray cancer cells in remaining breast tissue Family System Changes During The Childbearing CycleStructurePowerBoundariesAffect or

15、feelingsIntergenerational patterns and rolesCommunication patternsCultural background and rituralsBonding and AttachementBonding 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, unders

16、tand that childbearing is a major transition I the life of a familyNursing intervention for the three Phases of crisis Precrisis: Predictable and development events in the life cycleDiscuss change with family structure, adding new memberAssess risk factors, past coping and problem solvingImplement h

17、ealth teachingImplement health promotion and maintenance strategiesNursing intervention for the three Phases of crisisCrisis: Coping strategies not sufficient to deal with changes in family structure and problem in developmentClarify the problemAssist the family in going an understanding of the situ

18、ationAcceptance of the familyUse appropriate interpersonal and institutional resourcesAssess family to express feeling & ways of solving problem Nursing intervention for the three Phases of crisisPostcrisis: Crisis has been resolved, leading to a higher, the same, or lower of family functionSupport

19、the family in its new strategies of resolutionEmphasize growth potential in solutionsAttempt to reverse or lessen effects of maladaptation through appropriate rehabilitative effort or therapyPsychosocial aspects of childbearing Theories1. Psychosocial Change in the mother: Accepting the pregnancySym

20、bolic meaning of the pregnancySelf-image and body image during pregnancyPsychosocial aspects of childbearing Theories2. Role Assumption and maternal AdaptationMaternal IdentityMaternal role attainment: Motivation for motherhood, preparation for motherhood, conflict resolution, maternal attachment be

21、havior, relationship with motherRole conflict and attainment of the maternal roleRole conflict and attainment of the maternal roleInability to achieve the “good Mother”roleLack of knowledge and preparation for the maternal roleEstablishing a relationship with the fetusMaternal Ambivalence in Pregnan

22、cy No questions asked about pregnancy, labor and delivery, infant careNo interest in fetusPast negative experience with pregnancy or labor and deliveryDenial of pregnancy and fetal movement Pregnancy and parenthood interfering with life styleContinue activities that may hurt the fetus (smoking or dr

23、inking)Reporting persistent and many physical complains. Rh ImmunizationCheck by Indirect Coombs test to detect antibodies in the serum that target red blood antigens to cause fetus hemolysisAntibody titer 1:16 indicates possibility of severe hemolytic diseases Mother with Rh-negative: should receiv

24、e Rhogam within 72 hours (any invasive procedure that may cause the mixing of the maternal blood with fetus)Psychosocial aspects of childbearing Theories3. Psychosocial Change in the father: Development of the father roleParticipation in the childbearing cycleFather-infant interactions and the fathe

25、r 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 PregnancyKey terms: AcquaintanceAmbivalenceAttachmentAvoidanceBondingMrs. H. 33 wks shared that her husband was afraid of harming th

26、e unborn baby during intercourse. Which is the best response 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 an

27、d notify the doctor”“vaginal Penetration is prohibited anyway during the last month of pregnancy because of the dangers of infection” 3When teaching prospective fathers about pregnancy and birth, the nurse should plan to include which priority information?The possible difficulties in each trimesterT

28、he cost of caring and raising a childThe normal range of feeling that may experienced in different stages of pregnancyThe importance of his role in the act of conception and in the determination of the sex of the fetus. 3Pregnancy and weight gain First Trimester: 2-4 pounds (0.9-1.8 kg), 1 pound per

29、 week (0.45 kg) during 1st & 2nd trimesterTotal weight gain 13.18 kg or 29 poundsPregnancy and NutritionObesity: recommend to gain wt 7-11.5 kgUnderweight 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 i

30、mprove 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 diabetesUrinary tract infectionsInadequate weight gainWound infectionThromboembolismPIHFetal monitoring difficultyProlonged laborFetal Macroso

31、miaBirth trauma Question-NutritionIn comparison with a single fetus pregnancy, nutrition needs when there are twins much include: Increased calorie intake of 300 per fetus each dayLow-salt foods to prevent edemaAdditional fluid intake of 2-3 glasses per dayIron and folic acid needs for 10% more per

32、dayWarning Signs in PregnancyHeadacheAltered vision: blurring, double vision, seeing spotsNausea/vomitingEpigastric pain/abdominal painMuscular irritability/seizuresSigns of infection:fever, burning in urination, flank pain, diarrhea,Vaginal bleedingDecrease or cessation of fetal movementAssessment

33、for Neural Tube Defects“open” neural tube defects leak alpha-fetoprotein (AFP)Elevate AFP level in maternal serum and amniotic fluid may indicate the fetus has neural tube defectsAmniocentesis Performed around 15-18 weeks of gestation to identify genetic abnormality Risk: Trauma to the fetus, placen

34、ta, umbilical cord, or maternal structuresInfectionPremature labor and spontaneous abortionAmniocentesisWarning signs after receiving amniocentesis:Body temperature elevationFluid leaking from the vaginalMild Cramping and abdominal achingDecreased fetal movementChorionic Villus SamplingTo detect gen

35、etic or chromosomal defectsCan be done in early pregnancy 9-10 weeks gestationRisk: 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-beingC

36、heck 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 demonst

37、rating 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, G6PDNursing and family with Genetic disordersPerform Kar

38、yotype examinationGenetic Counseling-support for decision making Genetic screen for potential riskAssisting the client to cope with First-Trimester DiscomfortsNausea/vomiting-morning sicknessPtyalism “excess saliva in the mouth”Altered tasteBleeding gumsBreast tendernessUrinary frequencyNasal stuffi

39、ness and EpistaxisIncreased vaginal secretionFatigueEnsure Safety and removing barriers to carePromoting client safety: home, work, lifestyle, environment, danger/warning signs of pregnancyRemoving barriers: Social Economic factors, lack of insurance, inability to pay, lack of free prenatal service,

40、 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 TrimesterAware of that the pregnancy can be recognized by othersAcceptance of pregnancyMaternal role attainment: fetus movemen

41、t fosters internalization and fantasyFantasies: binding to infantsRelationship with motherBody image: begins to view fetus as separate form own body, change the perception of body boundary as protective barrier to fetusQuestionThe nurse should assess for which developmental task of the pregnant wome

42、n in her third trimester? Bonding to the fetus in preparation for birthAccepting the fetus as a wanted responsibilityUnderstanding the baby is an independent beingPreparing to separate from the fetus through the birth processQuestion-DM motherThe nurse teaches the newly pregnant diabetic the importa

43、nce of self glucose monitoring in the first trimester to prevent: Hypoxia in the fetusThe onset of diabetes in fetusUnusually large fetal developmentTeratogenic effects of hyperglycemia Question- Preterm LaborMagnesium Sulfate may be prescribed as a tocolytic drug because one of the expected actions

44、 is: Promoting diuresisLowering blood pressureInducing sedation and restPromoting smooth muscle relaxationPain during labor Analgesia: demerol (meperidine) Sedative: Seconal and Nembutal Narcotic analgesics: Fentanyl, Stabol Anesthesia: Marcaine (Bupavacaine) Alfenta (Alfentani) Epidural Block Give

45、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 bodyLabor stimulation by Oxytocin may needPrevent Hypotensive effect (500-1000 ml Lactated Ringers)Monitoring uterus contraction and fetus condition Side Effects of

46、Epidural Analgesia Respiratory depression in newborn (Narcan)Pruitus (itching)Nausea and vomiting Urinary retentionHypotensive Affect labor process, unable to push during second stage of labor (assessment important)QuestionA Client has received an effective dose of epidural anesthesia. The IV rate i

47、s 250 ml/hour and position is semi-Fowlers. Her blood pressure has dropped significantly. The first nursing intervention is to: Slow the rate of IV infusion to avoid overloadRetake the BP, initial hypotension is expectedBegin oxygen by face mask, lower head, elevate legs. Call back anesthesiologist

48、to deal with the conditionInduction 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, di

49、scomfort, progress of labor, complication Lamaze Technique QuestionThe nurse teaching the Lamaze technique evaluates her success when the couple do the following: Break the fear/tension/pain cycleBond successfully with the newbornUse positive feedback with each other during laborMaintain control dur

50、ing 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? Using muscle relaxation methodsInvalidating the perception o

51、f painRefocusing attention on another subjectImplementing anxiety reduction techniques In developing childbirth classes the nurse plans t include techniques that normally minimize pain perception, which of these are inappropriate?Using muscle relaxation methodsInvalidating the pain perceptionRefocus

52、ing attention on another subjectImplementing anxiety reduction techniquesVaginal 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 QuestionWhen membranes rupture spontaneously