Flashcards
1B - Care of the woman during pregnancy, labour and birth
Flashcards do conjunto (55)
- 1Models of care Biomedical and Social modelBiomedical: viewed as illness, managed according to timelines, reactive to symptoms, birth in hospital
Social: normal physiological process, sensitive to issues, partnership with women and HCWs, family involved, place of birth somewhere comfortable - 2Models of care Choices of caregiverspublic hospital, various professionals, private obstetrician, GP, mixed mode, midwife hospital, home, community
- 3How often should the woman vist?follow pattern
traditionally - confirmed with GP
First visit - history taken
USS at 18 weeks to confirm dates
Visits: 12-18 1st visit US, BP, uterine growth, listen to FH
4 weekly until 36 weeks then
2 weekly until 38 weeks then weekly
24 -26 weeks Blood sugar testing - 4Reminder - principles of ANCopen and reg communication - sharing info
involve significant others
accurate history
assessment and screening of mother and baby
information about pregnancy
health promotion
advice and education - 5Antenatal historyGeneral health - cervical smears, smoking status, alcohol/drug, BP, pulse, urinalysis, meds, supplements, weight
Medical illnesses- operations, procedures, blood transfusions, allergies, infections, physical sexual abuse
mental health - depression, anxiety
obsteric - contraceptives used, previous pregnancies and their outcomes
social - supports, resources, employment, relationship (partner) - 6Antenatal history (cont)family history - medical health probelms (cardiac, renal, resp, congenital, chromosomal)
emotional - feelings, parenthood, feelings about preg, was it planned?
cultural - identity, race, isolation, safety
spiritual - beliefs, any that influence choices, needs
current preg - last period, menstrual cycle history, expected date of birth, preg test confirmed or not - 7antenatal test - at each vistfeelings of mother
information/education re preg, birth, feeding, parentiing, partner
growth of foetus
BP monitoring
nutritional status
Blood tests, scans, results
Common probelms and their management
questions from mother and partner or support person - 8Maternal and foetal well-beingweight prn
gestation
BP
abdominal palpation
Symphysial fundal height (measure of top of uterus to top of symphisis pubis to assess growth and development of baby)
after 30 weeks - presentation and position of fetus
fetal movements - 16- 20 weeks
fetal HR - 12 weeks of more
anti - D prophylaxis - rh -ve at 28 + 34 weeks - 9antenatal screeningblood screen
maternal serum screening
harmony prenatal test ?
18-20 week USS
26-28 week OGCT, CBP, Ab screen
35-39 week GBS ) Group B strep status) - 10Educationintegral to good ANC
may be organised or planned classes
may be question - based discussion
groups or individuals
conducted by midwife, physio, dietician etc
may be held in hospital, home, community
information also gained by social media, books, family, friends - 11education should/could includehealth promotion - nutrition, exercise, reduction in hazard substance use
preparation for child birth - plans, process of birth, expectation, coping
preparation for early parenting - care of new born, settling, crying, sleeping, SIDs risk - 12Discomforts during pregnancy* mostly due to hormonal changes and growing uterus
- nausea, vomiting, due to rise in beta HCG
- reduced GIT motility
-constipation, haemorrhoids - progesterone effects
-pruritis in vagina
-fluid retention/oedema - changes in CV (increased venous pressure) - 13Nausea and vomiting80-85% of pregnant women
onset 5-6 weeks - 8
most resolved by 12-14 weeks or 16-18 weeks
cause: raised beta HCG/changes in BSL
not confined to morning
altered sense of taste and smell - 14Nutrition for discomfort and pregnancy common disordersN/V - small frequent meals, avoid spicy foods, eat carbs, eat protein before heading to bed, reduce coffee/tea
constipation - mild laxative okay (lactulose), increase water intake, high fibre
reflux- small frequent meals, eat slowly, avoid fatty spicy foods - 15management of other discomforstsHaemorrhoids - reduce constipation, topical creams
pigmentation - ? bio oil
gum bleeding - rinse mouh, cool fluids, soft brush
pruritus - good hygiene, wear cotton underwear, use topical creams
lordosis - good posture - 16anaemia in pregnancyblood volume increases 30-50% between 7 - 34 weeks gestation
plasma increases at a faster rate
leads to haemodilution
hb conc is decreased 100-150g/l
fetus needs iron for growth
iron supplements if low hb 26-28 week screen - 17Infections during pregnancycan lead to maternal and foetal morbidity and mortality
reduced foetal growth
risk of transfer to foetus - intra-uterine
transfer vertically during birth
can be bacteria, viruses, parasites, fungus
identified through antenatal screening
treated with abx - 18effects of infections maternal and foetalmaternal: miscarriage, still birth, ectopic preg, septicaemia, meningitis
foetal: neonatal sepsis, death, low birth weight, resp distress, blind, deaf - 19Labour definitionprocess by which fetus, placenta, and membranes are dispelled from the uterus through the birth canal
- 20Labour defined - normalspotaneous
term onset
foetus presents head down (vertex)
completed in 12- 18 hours
no complications - 21pre labourchanges in last few weeks of pregnancy
braxton hicks contractions - 22signs of false labourcontractions are not regular
cervix does not dilate
no progress - 23Onset of labourless precise in human species
not fully understood
numerous hypotheses
foetal trigger, uterine stretch, role of hormones - 24four essential forces of labourpassage, passenger, powers, psyche
- 25passage definedpelvis:
critical measures are
width and length
curve and length of sacrum
angle bones - 26passenger definedfoetus:
skull size, diameter
flexion of body and head
presentation - head first or buttocks
position - back of head (occiput) versus maternal pelvis
foetus adjusts position when they negotiate the birth canal - 27foetus negotiating positions in birth canaldescends, flexes, rotates, extends, expulsion
- 28powers definedcontractions:
start at top of uterus
stronger in upper area
weakest in lower area
uterine muscles retract
become shorter and thicker
cervix opens
electrical and contraction activity - controlled by:
muscles, nerves, hormones
slow rhythmic fluctuations of pressure that can be graphed
monitor FHR in response to contractions - 29Maternal positionstanding, squatting, kneeling, sitting
- relaxes uterine wall, enhances descent of uterus, reduces backache, improves placental perfusion, increases cervical pressure
side lying
- does not optimise foetal alignment with pelvis and descent of foetal forehead
does not maximise pelvic diameters
lengthens labour - 30psyches -definedfactors affecting -
self confidence, pattern of coping with stress, expectations of birth, attitudes to birth, response to stress, anxiety, pain - 31signs of true labourcontractions: reg, rhythmic, increase in length, strength, frequency
show: pink/red mucous vaginal discharge, detaching chorion from cervis - 32Stages of labour - stage onecontractions become longer, frequent, stronger
dilatation of cervix - 0-10 cm - 33care during first stage of labourencourage mobility
change position often
keep up food/fluids
provide support
manage discomfort
monitor maternal + foetal well-ceing
watch for signs of birth and prepare - 34management of discomfortdiversion therapy
breathing exercises
meditation
hypnotherapy
inhalation - nitrous oxide
IM analgesia=pethidine
epidural /spinal - 35Stages of labour - stage 2from full dilatation of cervis until expulsion of foetus
- 36care during stage 2 of labourmonitor maternal wellbeing
monitor foetal heart rate and rhythm
watch for signs of foetal head crowning - 37stage of labour - stage 3expulsion of placenta and membranes
- 38care during third stagewatch for signs of separation
cord lengthens
gush of fresh blood
placenta visible at vaginal opening
watch for bleeding (normal up to 500mls) - 39variations on normalspotaneous vaginal birth (normal)
induced vaginal birth
breech birth (normally LSCS)
instrument birth - forceps/ventouse
elective caesarian section (LSCS)
emergency caesarean section - 40pueperiumthe time period from end of labour and birth until reproductive organs have returned to their pre-pregnant state
usually takes 6 weeks
also called postpartum or postnatal period - 41involutionreproductive organs return to pre-pregnant state
uterus contracts immediately after birth
starts involution
takes 6 weeks in total - 42Involution - uterusuterine contractions: reduce bulk and size over time, from 1000gms to 50gms, fundus at umbilicus after birth - very firm, slowly decreased until non-palpable
placental site: sealed off by muscle contractions, thrombi form within uterine blood sinuses and seal off area, endometrial tissue covers site, no scar left - 43Involution - lochiavaginal discharge after giving birth
decidua (uterine lining during pregnancy) is shed and new endometrium begins to grow
vagina blood flow after childbirth up to 6 wks postnatal
consists of decidua cells, wbc, mucus, bacteria - 44Involution contclotting factors raised - potentional for thrombis
cervix softens and reduces blood vessels
ovaries, vagina, vulva, pelvic floor return to normal
menstrual cycle returns 12-18weels
breast feeding takes longer - 45Breastsreproductive organ in a progressive state
oestrogen and progesterone withdrawal after birth stimulates- prolactin to produce milk, oxytocin to contract milk ducts - 46other changescardiac reduction of blood volume through urine output and perspiration - 48 hours
watch bladder tone *
WCC increase as body defense against infection and aids healing
abdo and pelvic floor gain tone
falling progesterone - GIT increases motility
less constipation
* watch first few days of reflex inhibiton of defecation by perineal trauma and discomfort - 47Maternal health assessment/ carefundal height - firm, reducing 1cm a day (top of pubic bone to tip of uterus)
lochia - amount, color
vital signs - infection
bowel use
bladder use - tone, output
perineum/wound - clean
legs
breasts/nipples
hydration/diet - 48perineal carepain relief important and underestimated
ice packs 20 min onn/off
hygiene
frequent pad changes
observe for healing, bruising, haematoma
avoid constipation
encourage pelvic floor exercises - 49bladder careencourage voiding
ensure sufficient voiding (200-300 mls) 4-6 times a day
incontinence a hidden probelm
pelvic floor exercises important - 50post natal fatiquecommon
can take 2 months
related to sleep disturbance before and into postnatal period
loss of energy - 51postnatal exercisesperineal trauma and pain can add loss of sensation, pelvic floor care, back care, abdominal care
- 52educationlactation physiology
infant care
pelvic floor/back exercises
feeding
community resourses - 53psychosocial carehormonal changes
physical changes
social and cultural expectations
bond with baby
eye, physical contact
early breast feeding/care - 54breast feedingbest and healthiest way for infant and mother
formula not the same as breast mile
unique formula of nutrients and other substances needed for the baby's growth and cell function - 55nursing processassessment - during pregnancy, labour, birth, post natal periods important
planning- care with woman, partner, HCW
implementation - evidence based care, safety of mother and baby
evaluate - effectiveness of care
reflection - on care and overall process
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- O usuário eliminou as informações de disciplina FlashCards sobre 1B - Care of the woman during pregnancy, labour and birth, criado por Usuário eliminado em 14-06-2018.
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- Criado por Elizabeth Then · 14 jun 2018
- Copiado por Elizabeth Then · 14 jun 2018
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