Welcome to - PowerPoint PPT Presentation

Loading...

PPT – Welcome to PowerPoint presentation | free to download - id: 6a0d2b-MzYyM



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Welcome to

Description:

welcome to obstetrics rev. jan 2013 – PowerPoint PPT presentation

Number of Views:0
Avg rating:3.0/5.0
Slides: 102
Provided by: lwit
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Welcome to


1
Welcome to
  • OBSTETRICS
  • Rev. Jan 2013

2
  • Antepartum-betw. Conception to the onset of labor
  • Intrapartum-labor delivery
  • Postpartum/Puerperium-from delivery up to 6 wks.

3
Obstetric Terminology
  • Gravida
  • Primigravida
  • Multigravida
  • Para
  • Primipara
  • Multipara

4
Five Digit System
  • G Gravidity
  • T Term
  • P Preterm births
  • A Abortions
  • L Living Children

5
Factors Influencing Modern Maternity Care
  • Emphasis on prenatal care
  • Natural Childbirth
  • Epidural Analgesia
  • Education of Parents
  • Birthing Center/Midwives

6
Uterus
  • Has 3 layers
  • 1. Perimetrium
  • 2. Myometrium
  • 3. Endometrium
  • Provides housing nourishment
  • Fertilized ovum implants there

7
Vagina
  1. Birth canal
  2. Excretes menstrual flow
  3. Consists of Rugae
  4. Bartholins Glands

8
Perineum
  • Area bet. Posterior vaginal wall anus
  • Provides muscular support for pelvic organs

9
Structures that Support the Uterus
  • Broad Ligament
  • Round Ligament
  • Uterosacral Ligament
  • Support the uterus in its proper position

10
Pelvic Types Characteristics
  • 50 of women have gynecoid pelvis
  • Larger wider than male pelvis
  • Contains and protects reproductive organs,
    bladder rectum
  • Forms part of the birth canal

11
False Pelvis
  • The upper flaring part of pelvis
  • Supports growing uterus during pregnancy
  • Offers landmarks for pelvic measurement
  • Directs fetus toward True Pelvis

12
True Pelvis
  • Formed by pubis(front), the ilia/ischia(sides)
    and sacrum/coccyx(behind)
  • Inlet?entrance from false pelvis
  • Cavity?curved area
  • Outlet?exit from True pelvis

13
(No Transcript)
14
(No Transcript)
15
Menstrual Cycle
  • usually 28 days
  • day 1?menses begins
  • day 14?ovulation occurs

16
Physiology of Pregnancy
  • Must occur w/I 48 hrs. of ovulation
  • After fertilization?6-8dys for zygote to travel
    for implantation
  • Without fertilization?hormone levels drop,
    menstruation occurs.

17
Hormonal Control
  • FSH?secreted by ant. Pituitary
  • Stimulates graafian (ovarian) follicle in ovary
  • Ovum matures in graafian follicle
  • Estrogen.
  • LH..

18
Progesterone
  • Secreted by corpus luteum
  • Causes endometrium to thicken
  • Essential in maintenance of pregnancy

19
If Fertilization occurs
  • The corpus luteum secretes progesterone
    estrogen for 11-12 wks, then placenta takes over
    production of these hormones
  • HCG is secreted

20
If Fertilization does not occur
  • corpus luteum dies
  • Estrogen progesterone levels decrease
  • Endometrial degeneration occurs menstruation
    begins.

21
CONCEPTION
  • Takes place in fallopian tubes
  • Occurs after ovum sperm unite
  • There are 23 chromosomes in each?
  • 46 chromosomes Zygote

22
http//www.youtube.com/watch_popup?vfKyljukBE70
23
Determination of Sex
  • Determined by fathers sperm
  • Female ovum has only x chromosome
  • Male sperm has both x y chromosome

24
2 Types of Multiple Births
  • Monozygotic
  • Identical Twins
  • single ovum sperm
  • fertilized egg dev.?2 embryos
  • usually 1 placenta (2 sacs)
  • always the same sex

25
Dizygotic Twins
  • Fraternal Twins
  • 2 ova 2 sperm, both implant
  • 2 placentas (separate or fused) w/ 2 sacs
  • May/may not be same sex
  • May/may not look alike

26
Lab Tests to Determine Pregnancy
  • Most based on presence of HCG in blood or urine
  • HCG is present anywhere from 8-15 days after
    conception
  • Home test are 95 accurate
  • Use first void in morning

27
E.D.C.- Estimated Date of Confinement
  • Calculated by Nageles rule
  • Count back 3 mos. From the 1st day of LMP
  • Add 7 days

28
Determination of Pregnancy
  • 3 Degrees of Certainty based on Symptoms
  • a. Presumptive
  • b. Probable
  • c. Positive

29
Presumptive Signs Sx
  • Amenorrhea
  • Nausea vomiting
  • Frequent urination (1st 3rd trimester)
  • Fatigue
  • Breast changes

30
  • Pigmentation Changes
  • Quickening(first fetal movement)
  • Change in abdomen shape size
  • Chadwicks Sign

31
Probable Signs Sx
  • urine pregnancy test
  • RIA test
  • Goodells sign
  • Hegars sign
  • Ballottement

32
Positive Signs Sx
  • Fetal Heart Beat
  • faint _at_ 10-12 wks. With doppler ultrasound
  • Distinct _at_ 18-20 wks.
  • 120-160 beats/min.
  • X-ray visualization

33
Maternal Fetal Circulation
  • Placenta
  • Dark red circular organ
  • Weighs 1-2 lbs.
  • Dev. From both embryonic maternal tissue
  • Totally formed and functioning by 12 wks.

34
  • Maternal side (decidua basalis)
  • Fetal side has chorionic villi

35
Placental Functions
  1. Provides for nutrition, excretion respiration
    of fetus
  2. Secretes progesterone
  3. Secretes estrogen
  4. Secretes HCG
  5. Acts as protective barrier

36
Placental Transfer
  • Exchange of nutrients, excrement respiration
  • There is NO intermixing of fetal maternal blood
    .

37
Umbilical Cord
  1. Attaches fetus to placenta
  2. Contains 2 arteries 1 vein (intertwined
    covered by Whartons jelly)

38
Fetal Circulation
  1. Umbilical vein?carries oxygenated blood
    nutrients from placenta to fetus
  2. Umbilical arteries?carry waste products from
    fetus to placenta

39
(No Transcript)
40
  • Know..
  • 1.Ductus Venosus
  • 2.Foramen Ovale
  • 3. Ductus Arteriosis

41
Physiological Changes Common Discomforts of
Pregnancy
42
A. Cardiovascular
  • Blood volume up 30-40
  • Heart rate up
  • BP remains unchanged

43
B. Respiratory
  • Rate is increased
  • Lung capacity is decreased
  • S.O.B.

44
(No Transcript)
45
C. Digestive
  • Stomach intestines displaced upwards
  • Peristalsis slows? constipation
  • Nauseau? cau. By hormones
  • Heartburn? due to reflux of stomach contents

46
D. Endocrine
  • Glands increase in size activity
  • Metabolic rate increases
  • Yellowish discharge from breasts is
    called_______?
  • Caused by the hormone known as __________?

47
E. Musculoskeletal
  • Lordosis
  • Pubic symphysis sacroiliac joints become more
    pliable
  • Pendulous abdomen strains M/S system? backaches

48
F. Urinary Vaginal
  • Kidney activity increases
  • Urinary frequency ( 1st and 3rd)
  • trimesters
  • Vaginal discharge is common

49
G. Integumentary
  • Striae on abdomen, hips, thighs, breasts
  • Pigmented mask on face
  • (chloasma)
  • Increase pigmentation abdomen (linea nigra)

50
Prenatal/Antepartal Care
  • GOAL
  • Maximum physical mental fitness of woman with
    an uncomplicated delivery healthy newborn

51
Routine Antepartal Care.
  • Initial exam history
  • Appts. Q mo. ? 7 month
  • Q 2 wks for next month
  • Wkly until delivery
  • Exams include BP, wt, fundal ht, fetal heart
    rate.

52
NUTRITIONAL NEEDS
  • Diet based on Food Guide Pyramid
  • Increase calories by 300 daily
  • Increase calcium
  • Meats? zinc, iron and protein
  • Folic acid supplements

53
  • Increase protein intake for fetus mother
  • Avoid empty calories
  • Iodized salt
  • Variety of foods
  • No laxatives/enemas

54
  • Increase fluids (8-10 glasses/day of water
  • Increase vitamins
  • Weight gain varies w/ weight of mother
  • Appetite ( Pica )

55
GENERAL PRACTICES during
Labor
  • Why Left side lying??
  • Coping and stress tolerance
  • Role of the doula, father and partner??
  • How are Seat Belts worn?

56
TERATOGENIC FACTORS
  • Teratogen is an environmental agent or factor
    that causes defects in fetus.
  • Ex Rubella, ETOH, smoking, drugs, dietary
    deficiencies

57
CRITICAL THINKING QUESTION
  • What are the danger signs and symptoms during
    pregnancy???
  • What is the 1 danger sign regardless of
    pregnancy stage???

58
Complications of Pregnancy
59
ABORTIONS
  • A. Spontaneous
  • B. Therapeutic

60
KNOW.
  • All the types of Spontaneous Abortions and
    Therapeutic Management be prepared to discuss
    them in class.
  • Box 28-3 pg. 889

61
Incompetent Cervix
  • Etiologic factors
  • Previous cervical lacerations
  • Cervical or vaginal CA
  • Multiple D Cs or biopsies
  • Congenital exposure to DES
  • TX ? Cervical Cerclage

62
Ectopic Pregnancy
  • Implantation occurs somewhere other than the
    uterus
  • Other sites? abdominal cavity, ovaries, ligaments
    or cervix
  • 95 occur in fallopian tubes

63
(No Transcript)
64
Clinical Manifestations
  • Sharp, localized, one-sided pain or pain
    referred to the shoulder
  • Rigid and tender abdomen
  • Slight vaginal bleeding
  • Signs of hypovolemic shock

65
Treatment
  • Surgical treatment must be prompt
  • Salpingectomy
  • Salpingostomy
  • Methotrexate

66
Maternal Disorders Affecting Pregnancy
67
Hyperemesis Gravdiarum
  • Excessive vomiting
  • Exact cause is unknown
  • HCG is suspected
  • H. pylori recently linked
  • Common nutrition-related discomforts of pregnancy

68
Clinical Manifestations
  • Vomiting retching
  • Severe dehydration
  • Acid base inbalance
  • Hypokalemia
  • Vitamin deficiencies may lead to jaundice and
    hemorrhage

69
Nursing Assessment
  • Frequency, amount character of emesis.
  • I O
  • Skin turgor and mucous membranes
  • Psychosocial assessment
  • Assess fetal status

70
Medical Management
  • Meet nutritional needs
  • Balance electrolytes with IV
  • TPN used in severe cases
  • Reintroduce solid foods slowly
  • Prognosis is good

71
( GH ) Gestational Hypertension
  • Progressive disease unique to pregnancy
  • Pre-eclampsia (Mild or Severe)
  • Eclampsia

72
Classic Signs..
  • Edema
  • Hypertension
  • Proteinuria (albuminurea)
  • Signs generally occur after 20th wk of pregnancy

73
Mild Preelampsia
  • Few clinical symptoms
  • BP of 140/90
  • Generalized edema of face, hands and ankles
  • Weight increase, 1-2 albumin in urine

74
Severe Preeclampsia
  • Symptoms appear suddenly
  • BP of 160/110 or greater
  • Increased edema
  • Dramatic increase in weight
  • Increase urine albumin decrease in urine amount

75
Eclampsia
  • Most severe form of PIH
  • Characterized by seizures coma
  • Elevated BP, albuminuria and oliguria are common
    also

76
Nursing Interventions
  • I O and dly weights
  • Monitor BP every 4 hrs.
  • Quiet environment bedrest
  • Magnesium Sulfate-gt used to prevent convulsions,
    lower BP
  • Main purpose for trmt is to prevent convulsions

77
Eclamptic Seizure Precautions Interventions
  • Review pg. 899 Box 28-4

78
Nursing Alert HELLP Syndrome
  • H ? Hemolysis (destruction of RBCs)
  • EL? Elevated Liver Enzymes
  • LP ? Low Platelet Count

79
Gestational Diabetes
  • Diabetes during pregnancy
  • Screened at 26-28 wks
  • Ranges from diet controlled?insulin
  • Most gestational diabetes return to normal after
    delivery

80
Clinical Manifestations
  • Blood glucose levels gt 120 mg/dl
  • Classic symptoms of diabetes
  • See Box 28-8

81
Nursing Interventions
  • Maintain normal blood glucose
  • Teach? how to administer insulin regulate blood
    sugars
  • Insulin may be required by both NIDDM and GDM
  • Insulin will not cross placenta

82
Critical Thinking Question
  • What would your teaching include for the newly
    diagnosed diabetic woman?

83
DISORDERS AFFECTING THE FETUS
84
1. INFECTIONS
  • T ? Toxoplasmosis
  • O ? Other
  • R ? Rubella
  • C ? Cytomegalovirus
  • H ? Herpes

85
2. Hemolytic Diseases
  • Rh Sensitization
  • ABO Incompatibility

86
Rh Sensitization
  • Less frequent today
  • Rh proteins enter maternal circulation of Rh-
    mother she now produces Rh antibodies.
  • Antibodies destroy the fetus RBCs causing
    Erythroblastosis Fetalis
  • Trmt ? Rhogam injections

87
ABO Incompatability
  • Also is an antigen-antibody process
  • Usually not detected before birth
  • Usually see jaundice w/i 24 hrs
  • Rx with phototherapy

88
PLACENTAL AMNIOTIC DISORDERS
89
1. Placenta Previa
  • Placenta partially or completely covers the
    cervical os
  • Complete with total coverage
  • Partial with incomplete coverage
  • Marginal

90
Clinical Manifestations
  • Painless vaginal bleeding occurring after 20
    weeks usually during last trimester
  • Soft, non-tender uterus

91
Diagnosed by
  • Obstetric Ultrasound
  • Medical Management
  • Bedrest/observation
  • C-section preferred

92
2. Abruptio Placenta
  • Abrupt premature separation of normally implanted
    placenta
  • Grave complication of late pregnancy
  • Cause is unknown

93
Predisposing Factors
  • Gestational Hypertension
  • Substance abuse
  • Grand multipara
  • Numerous abortions

94
Symptoms are
  • Pain, dark red blood, tender uterus usually in
    last trimester
  • Strong, consistent contractions
  • Rising fundus (uterine rigidity) may indicate
    retroplacental hemorrhage

95
Treatment/Management is
  1. Continuous fetal monitoring
  2. Monitor fundal height (marking to check for
    upward movement.
  3. Freq. VS
  4. If no fetal distress? vag delivery
  5. If s/s of fetal distress ? C/S

96
Prognosis
  • Depends on extent of detachment
  • Blood loss
  • DIC
  • Time between separation delivery

97
CRITICAL THINKING QUESTION
  • WHEN THERE IS BLEEDING OF ANY KIND DURING
    PREGNANCY, WHAT SHOULD THE NURSE ASSESS FOR???

98
Know for class discussion the following Fetal
Well-Being Tools
  • A.Amniocentesis
  • B. Chorionic Villi Sampling
  • C. Ultrasound Scanning
  • D. Contraction Stress Test
  • E. Nonstress Test (NST)

99
  • F. Fetal Biophysical Profile
  • G. Alphafetaprotein

100
CRITICAL THINKING QUESTION
  • A pregnant female has returned for her second
    prenatal visit. The nurse is unable to auscultate
    a fetal heart rate. The physician orders an
    ultrasound. The patient is concerned about her
    baby and asks why an ultrasound is to be
    performed. How should the nurse manage this
    patient?

101
  • Done with Unit 1 OB
  • On to Unit 2 .. ?
About PowerShow.com