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Review of Maternal-Infant Nursing


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Title: Review of Maternal-Infant Nursing

Review of Maternal-Infant Nursing
  • ???
  • ??????????
  • 2006-4-27

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

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
    pituitary- stimulating the secretion of FSH
  • 4. Premenstrual phase Decline in estrogen and

The Menstrual Cycle
  • Endometrial Cycle
  • Proliferative phase
  • Secretary phase
  • Menstrual phase

  • FSH stimulates which processes in the menstrual
  • Thinking of endometrium
  • Maturation of follicle
  • Decrease in basal body temperature
  • Increase in progesterone production

Infertility Care
  • Infertility affects 15-20 of the populations in
    the reproductive yearsTerms 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
  • Ovulatory Analysis
  • Sperm Analysis
  • Testing of STDS
  • Tubal Patency test

  • In which phase of the menstrual cycle is thick,
    scant cervical mucus and an elevated BBT seen?
  • Estrogenic phase
  • Menstrual Phase
  • Ovulatory phase
  • 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

  • Women should be taught to be aware of early
    warning signs of HIV infection which are
  • Dyspareunia
  • Severe dysmenorrhea
  • Occasional Candida infection
  • Recurrent episodes of genital warts

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

Family System Changes During The Childbearing
  • 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
  • Precrisis Predictable and development events in
    the life cycle
  • Discuss change with family structure, adding new
  • Assess risk factors, past coping and problem
  • Implement health teaching
  • Implement health promotion and maintenance

Nursing intervention for the three Phases of
  • Crisis Coping strategies not sufficient to deal
    with changes in family structure and problem in
  • Clarify the problem
  • Assist the family in going an understanding of
    the situation
  • Acceptance of the family
  • Use appropriate interpersonal and institutional
  • Assess family to express feeling ways of
    solving problem

Nursing intervention for the three Phases of
  • Postcrisis Crisis has been resolved, leading to
    a higher, the same, or lower of family function
  • Support the family in its new strategies of
  • Emphasize growth potential in solutions
  • 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
  • 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 gt 116 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
  • Acquaintance
  • Ambivalence
  • Attachment
  • Avoidance
  • 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?
  • Gentle vaginal intercourse is safe throughout
  • 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 and notify the
  • 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?
  • The possible difficulties in each trimester
  • The cost of caring and raising a child
  • The normal range of feeling that may experienced
    in different stages of pregnancy
  • 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 lt 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

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

Warning Signs in Pregnancy
  • Headache
  • Altered vision blurring, double vision, seeing
  • Nausea/vomiting
  • Epigastric pain/abdominal pain
  • Muscular irritability/seizures
  • Signs of infectionfever, burning in urination,
    flank pain, diarrhea,
  • Vaginal bleeding
  • Decrease or cessation of fetal movement

Assessment for Neural Tube Defects
  • open neural tube defects leak alpha-fetoprotein
  • Elevate AFP level in maternal serum and amniotic
    fluid may indicate the fetus has neural tube

  • Performed around 15-18 weeks of gestation to
    identify genetic abnormality
  • Risk
  • Trauma to the fetus, placenta, umbilical cord, or
    maternal structures
  • Infection
  • Premature labor and spontaneous abortion

  • Warning signs after receiving amniocentesis
  • Body temperature elevation
  • Fluid leaking from the vaginal
  • Mild Cramping and abdominal aching
  • Decreased fetal movement

Chorionic Villus Sampling
  • To detect genetic or chromosomal defects
  • Can be done in early pregnancy 9-10 weeks
  • 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

Genetic Problem
  • Autosomal Recessive Disorders 25 of the
  • Risk of passing the disorder to each of their
    offspring. 14 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,

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
  • 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,

Psychologic changes and concerns of a mother at
2nd Trimester
  • Aware of that the pregnancy can be recognized by
  • 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

  • The nurse should assess for which developmental
    task of the pregnant women in her third
  • Bonding to the fetus in preparation for birth
  • Accepting the fetus as a wanted responsibility
  • Understanding the baby is an independent being
  • 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
  • Hypoxia in the fetus
  • The onset of diabetes in fetus
  • Unusually large fetal development
  • Teratogenic effects of hyperglycemia

Question- Preterm Labor
  • Magnesium Sulfate may be prescribed as a
    tocolytic drug because one of the expected
    actions is
  • Promoting diuresis
  • Lowering blood pressure
  • Inducing sedation and rest
  • Promoting smooth muscle relaxation

Pain during labor
  • Analgesia demerol (meperidine)
  • Sedative Seconal and Nembutal
  • Narcotic analgesics Fentanyl, Stabol
  • Anesthesia Marcaine (Bupavacaine) Alfenta

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
  • 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)

  • 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
  • Slow the rate of IV infusion to avoid overload
  • Retake the BP, initial hypotension is expected
  • Begin oxygen by face mask, lower head, elevate
  • Call back anesthesiologist to deal with the

Induction or Augmentation of Labor
  • Induction starting labor artificially by
  • 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
  • Break the fear/tension/pain cycle
  • Bond successfully with the newborn
  • Use positive feedback with each other during
  • 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?
  • Using muscle relaxation methods
  • Invalidating the perception of pain
  • Refocusing attention on another subject
  • Implementing 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 methods
  • Invalidating the pain perception
  • Refocusing attention on another subject
  • 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

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

  • 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
  • Notify the physician
  • Check for vaginal bleeding
  • Apply oxygen by mask at 10 L/min
  • Rotate her to the left side-lying position

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

  • 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?
  • Call for physician at once
  • Turn client toward the left lateral position
  • Position client to relieve pressure on the cord
  • 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
  • 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?
  • Hyperthemia with flushed skin
  • Residual tremors after movement
  • Vigorous sucking on nipple or on fist
  • Frequent loose stools

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